MEDICARE: COLBY STEPHEN GINN ATP

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	247200000X	Other Technician	27341614	TX

General Provider Information

NPI Number	:	1326874918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLBY STEPHEN GINN ATP

Provider Business Mailing Address
First Line	:	3813 KELLNER RD
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-6202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2808 LONGHORN BLVD STE 308
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-7626
Country	:	US
Telephone Number	:	713-532-3395
Fax Number	:

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

Provider Enumeration Date	:	09/10/2024
Last Update Date	:	09/10/2024

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