MEDICARE: MRS. SUSAN GAIL MCILHENNY PA-C

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	363A00000X	Physician Assistant	PA00266	TX

General Provider Information

NPI Number	:	1467487496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN GAIL MCILHENNY PA-C

Provider Business Mailing Address
First Line	:	9615 SUMMER RUN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-5395
Country	:	US
Telephone Number	:	281-387-8148
Fax Number	:

Provider Business Practice Location Address
First Line	:	367 GREENS RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-1903
Country	:	US
Telephone Number	:	281-875-1800
Fax Number	:	281-875-1801

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/11/2011

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