MEDICARE: EBONIE D PAGE

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	1744P3200X	Prosthetics Case Management	1598682	TX

General Provider Information

NPI Number	:	1013477090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONIE D PAGE

Provider Business Mailing Address
First Line	:	7218 TOWERVIEW LN
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-2434
Country	:	US
Telephone Number	:	832-209-9889
Fax Number	:

Provider Business Practice Location Address
First Line	:	2531 CARTWRIGHT RD
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2606
Country	:	US
Telephone Number	:	832-209-9889
Fax Number	:

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

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	03/25/2019

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