MEDICARE: SIEMER 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	305S00000X	Point of Service

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1609349489	OTHER	TX	LORI RUSSELL-SIEMER

General Provider Information

NPI Number	:	1114482718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIEMER LLC

Provider Business Mailing Address
First Line	:	1930 SANTA ANNA DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-5611
Country	:	US
Telephone Number	:	817-706-1728
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 PEYCO DR N STE L
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-6701
Country	:	US
Telephone Number	:	817-706-1728
Fax Number	:

Authorized Official
Title or Position	:	LCSW
Name	:	LORI RUSSELL-SIEMER
Credential	:
Telephone Number	:	817-706-1728

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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Directions to “SIEMER LLC ” Practice Location

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