MEDICARE: LINDA N. HILLIS L.AC

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	171100000X	Acupuncturist	TX000768	TX

General Provider Information

NPI Number	:	1013191899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA N. HILLIS L.AC

Provider Business Mailing Address
First Line	:	601 UNIVERSITY DR
Second Line	:	106
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2168
Country	:	US
Telephone Number	:	817-703-7601
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 UNIVERSITY DR
Second Line	:	106
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2168
Country	:	US
Telephone Number	:	817-703-7601
Fax Number	:

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

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	12/28/2007

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