MEDICARE: NHI P LE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	K9105	TX
2	207R00000X	Internal Medicine Physician	K9105	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	110202064	OTHER	TX	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	943417821	OTHER	TX	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8AD895	OTHER	TX	BC/BS
5	0060466	OTHER	TX	BLUE LINK
6	7160045	OTHER	TX	AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003808163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NHI P LE M.D.

Provider Business Mailing Address
First Line	:	307 CALHOUN PLZ
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2421
Country	:	US
Telephone Number	:	361-551-2288
Fax Number	:	361-551-2338

Provider Business Practice Location Address
First Line	:	307 CALHOUN PLZ
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2421
Country	:	US
Telephone Number	:	361-551-2288
Fax Number	:	361-551-2338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	06/21/2011

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Directions to “ NHI P LE M.D.” Practice Location

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