MEDICARE: MELINDA J HISCOCK M.D.

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	207V00000X	Obstetrics & Gynecology Physician	J3677	TX

General Provider Information

NPI Number	:	1356329502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA J HISCOCK M.D.

Provider Business Mailing Address
First Line	:	3023 PERRYTON PKWY
Second Line	:	STE 202
City	:	PAMPA
State	:	TX
Zip	:	79065-2821
Country	:	US
Telephone Number	:	806-665-1500
Fax Number	:	806-665-1502

Provider Business Practice Location Address
First Line	:	3023 PERRYTON PKWY
Second Line	:	STE 202
City	:	PAMPA
State	:	TX
Zip	:	79065-2821
Country	:	US
Telephone Number	:	806-665-1500
Fax Number	:	806-665-1502

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	10/03/2007

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