MEDICARE: NISAL CORPORATION

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	174400000X	Specialist

General Provider Information

NPI Number	:	1013035732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NISAL CORPORATION

Provider Business Mailing Address
First Line	:	3915 SHAVER ST
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-2603
Country	:	US
Telephone Number	:	713-378-0030
Fax Number	:	713-378-0399

Provider Business Practice Location Address
First Line	:	3915 SHAVER ST
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-2603
Country	:	US
Telephone Number	:	713-378-0030
Fax Number	:	713-378-0399

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	VERONICA SIMS
Credential	:	CCS
Telephone Number	:	832-428-2963

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	12/06/2010

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Directions to “NISAL CORPORATION ” Practice Location

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