MEDICARE: ECHO HARMONY ROWLES CST, CSFA

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	246ZC0007X	Surgical Assistant
2	246ZS0410X	Surgical Technologist	138912	TX

General Provider Information

NPI Number	:	1700124997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ECHO HARMONY ROWLES CST, CSFA

Provider Business Mailing Address
First Line	:	5316 ROOSEVELT AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-2127
Country	:	US
Telephone Number	:	323-810-8686
Fax Number	:

Provider Business Practice Location Address
First Line	:	5316 ROOSEVELT AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-2127
Country	:	US
Telephone Number	:	323-810-8686
Fax Number	:

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

Provider Enumeration Date	:	01/22/2013
Last Update Date	:	08/14/2014

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