MEDICARE: PHYLLIS A VOLS RSA RST

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	174400000X	Specialist	238000045	IL
2	246ZC0007X	Surgical Assistant
3	246ZS0410X	Surgical Technologist	237000011	IL
4	363AS0400X	Surgical Physician Assistant	238.000045	IL

General Provider Information

NPI Number	:	1487634366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS A VOLS RSA RST

Provider Business Mailing Address
First Line	:	7324 SOUTHWEST FWY STE 1550
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2053
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7324 SOUTHWEST FWY STE 1550
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074
Country	:	US
Telephone Number	:	713-779-9800
Fax Number	:	713-988-8402

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	09/06/2018

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