MEDICARE: A&E LLC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1104579515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A&E LLC

Provider Business Mailing Address
First Line	:	1414 TEXAS ST UNIT 733
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-3680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 TEXAS ST UNIT 733
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-3680
Country	:	US
Telephone Number	:	832-657-2403
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ERIK HALLER
Credential	:
Telephone Number	:	832-657-2403

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	01/27/2022

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