MEDICARE: MS. THERESE ANN POPE MT(ASCP)

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	246QM0706X	Medical Technologist

General Provider Information

NPI Number	:	1356575591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESE ANN POPE MT(ASCP)

Provider Business Mailing Address
First Line	:	1135 18TH PL SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-6921
Country	:	US
Telephone Number	:	720-320-4665
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 18TH PL SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-6921
Country	:	US
Telephone Number	:	720-320-4665
Fax Number	:

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

Provider Enumeration Date	:	05/02/2009
Last Update Date	:	05/02/2009

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