MEDICARE: H MANOR 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	293D00000X	Physiological Laboratory
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	N8623	TX
3	246ZE0500X	EEG Specialist/Technologist
4	2472E0500X	EEG Technician
5	261QR0200X	Radiology Clinic/Center
6	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
7	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1255842183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H MANOR LLC

Provider Business Mailing Address
First Line	:	PO BOX 141331
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75014-1331
Country	:	US
Telephone Number	:	615-566-0066
Fax Number	:	817-809-4355

Provider Business Practice Location Address
First Line	:	2200 PHYSICIANS BLVD STE C
Second Line	:
City	:	ENNIS
State	:	TX
Zip	:	75119-6248
Country	:	US
Telephone Number	:	615-566-0066
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES L. CARLISLE
Credential	:	MD
Telephone Number	:	615-566-0066

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	02/01/2021

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Directions to “H MANOR LLC ” Practice Location

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