=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295094787
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALTHEA SCOTT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2012
-----------------------------------------------------
Last Update Date | 05/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7818 GALLEON FIELD LN
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77433-6160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-216-0226
-----------------------------------------------------
Fax | 651-538-3707
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7818 GALLEON FIELD LN
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77433-6160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-216-0226
-----------------------------------------------------
Fax | 651-538-3707
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. ALTHEA SCOTT
-----------------------------------------------------
Credential | BS, CPT
-----------------------------------------------------
Telephone | 832-216-0226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------