MEDICARE: MACTIVA ANESTHESIA ASSOCIATES PLLC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	M8126	TX

General Provider Information

NPI Number	:	1669837209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACTIVA ANESTHESIA ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	1334 PIN OAK RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-6849
Country	:	US
Telephone Number	:	281-727-0076
Fax Number	:	281-727-0420

Provider Business Practice Location Address
First Line	:	1334 PIN OAK RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-6849
Country	:	US
Telephone Number	:	281-727-0076
Fax Number	:	281-727-0420

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. SCOTT H LIN
Credential	:	M.D.
Telephone Number	:	281-727-0076

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	12/28/2015

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