MEDICARE: MRS. ROSEANNA FREEMAN OPA C ST

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	246ZS0410X	Surgical Technologist	056191 - SUR TECH #
2	246ZS0410X	Surgical Technologist	056191-CERTSURGTECH	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	648	OTHER	TX	OPA CERTIFICATION

General Provider Information

NPI Number	:	1518182914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSEANNA FREEMAN OPA C ST

Provider Business Mailing Address
First Line	:	7777 FOREST LN
Second Line	:	C 135
City	:	DALLAS
State	:	TX
Zip	:	75230-2571
Country	:	US
Telephone Number	:	972-566-5564
Fax Number	:	972-566-7556

Provider Business Practice Location Address
First Line	:	7777 FOREST LN
Second Line	:	SUITE C-135
City	:	DALLAS
State	:	TX
Zip	:	75230-2571
Country	:	US
Telephone Number	:	972-566-5564
Fax Number	:	972-566-7556

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	02/10/2022

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Directions to “ MRS. ROSEANNA FREEMAN OPA C ST” Practice Location

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