MEDICARE: URBAN LINE 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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1356874622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBAN LINE LLC

Provider Business Mailing Address
First Line	:	2500 WOODLAND PARK DR APT C304
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-2278
Country	:	US
Telephone Number	:	713-714-4425
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 WOODLAND PARK DR APT C304
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-2278
Country	:	US
Telephone Number	:	713-714-4425
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	KATE ASAIJE
Credential	:
Telephone Number	:	713-714-4425

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	04/04/2017

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Directions to “URBAN LINE LLC ” Practice Location

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