MEDICARE: TERRY L MORRIS LSA

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	SA00258	TX

General Provider Information

NPI Number	:	1639201874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY L MORRIS LSA

Provider Business Mailing Address
First Line	:	8804 TEXAS SUN DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-6306
Country	:	US
Telephone Number	:	512-326-9111
Fax Number	:	512-280-6220

Provider Business Practice Location Address
First Line	:	8804 TEXAS SUN DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-6306
Country	:	US
Telephone Number	:	512-326-9111
Fax Number	:	512-280-6220

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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