MEDICARE: MR. TONY LANE HAMPTON LSA

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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1285760769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TONY LANE HAMPTON LSA

Provider Business Mailing Address
First Line	:	14713 NOYA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78728-4324
Country	:	US
Telephone Number	:	512-825-2417
Fax Number	:	512-953-0635

Provider Business Practice Location Address
First Line	:	14713 NOYA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78728-4324
Country	:	US
Telephone Number	:	512-825-2417
Fax Number	:	512-953-0635

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	02/29/2016

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