MEDICARE: TEXAS CDS & SUPPORT SERVICES

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	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1700035821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS CDS & SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	10636 CAYUGA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-2804
Country	:	US
Telephone Number	:	214-660-8507
Fax Number	:

Provider Business Practice Location Address
First Line	:	10636 CAYUGA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-2804
Country	:	US
Telephone Number	:	214-660-8507
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE ANN EASTHAM
Credential	:
Telephone Number	:	214-660-8507

Provider Enumeration Date	:	09/12/2008
Last Update Date	:	09/12/2008

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Directions to “TEXAS CDS & SUPPORT SERVICES ” Practice Location

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