MEDICARE: GEORGETTE DELCAMBRE HARRIS

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	343900000X	Non-emergency Medical Transport (VAN)	W15487	TX

General Provider Information

NPI Number	:	1518269471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGETTE DELCAMBRE HARRIS

Provider Business Mailing Address
First Line	:	1201 REDFORD
Second Line	:	#2219A
City	:	HOUSTON
State	:	TX
Zip	:	77034
Country	:	US
Telephone Number	:	713-878-3753
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 REDFORD ST
Second Line	:	#2219A
City	:	HOUSTON
State	:	TX
Zip	:	77034-1861
Country	:	US
Telephone Number	:	713-878-3753
Fax Number	:

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

Provider Enumeration Date	:	11/29/2010
Last Update Date	:	12/06/2010

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