MEDICARE: MRS. CHAMAIPORN V. GEIS NP, MSN

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	363LA2200X	Adult Health Nurse Practitioner	602290	TX
2	363LF0000X	Family Nurse Practitioner	602290	TX
3	363LG0600X	Gerontology Nurse Practitioner	602290	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8Y3603 BCBSTX	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1689692618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHAMAIPORN V. GEIS NP, MSN

Provider Business Mailing Address
First Line	:	9 GREENWAY PLZ STE 2950
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77046-0924
Country	:	US
Telephone Number	:	713-935-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 HIGHWAY 6 S
Second Line	:	REDICLINIC
City	:	SUGARLAND
State	:	TX
Zip	:	77479
Country	:	US
Telephone Number	:	281-325-0311
Fax Number	:	281-325-0312

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	11/07/2016

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