MEDICARE: NTX GERIATRICS LLC

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	207Q00000X	Family Medicine Physician
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1629521414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NTX GERIATRICS LLC

Provider Business Mailing Address
First Line	:	3013 W SPRING CREEK PKWY
Second Line	:	#400
City	:	PLANO
State	:	TX
Zip	:	75023-3953
Country	:	US
Telephone Number	:	469-724-4677
Fax Number	:	972-730-9344

Provider Business Practice Location Address
First Line	:	3013 W SPRING CREEK PKWY
Second Line	:	#400
City	:	PLANO
State	:	TX
Zip	:	75023-3953
Country	:	US
Telephone Number	:	469-724-4677
Fax Number	:	972-730-9344

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	DR. LORIE ANN BELITERE-BLESSING
Credential	:	MD
Telephone Number	:	469-724-4677

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	07/27/2016

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