MEDICARE: MR. GEORGE GAENSLEN BC-HIS

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	237700000X	Hearing Instrument Specialist	50223	TX

General Provider Information

NPI Number	:	1538324918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE GAENSLEN BC-HIS

Provider Business Mailing Address
First Line	:	11285 SOUTHWEST FWY
Second Line	:	#180
City	:	HOUSTON
State	:	TX
Zip	:	77031-3619
Country	:	US
Telephone Number	:	281-530-8300
Fax Number	:	281-498-4979

Provider Business Practice Location Address
First Line	:	11285 SOUTHWEST FWY
Second Line	:	#180
City	:	HOUSTON
State	:	TX
Zip	:	77031-3619
Country	:	US
Telephone Number	:	281-530-8300
Fax Number	:	281-498-4979

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

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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