MEDICARE: HSCC AFFILIATE GROUP

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	171W00000X	Contractor
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1720349756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HSCC AFFILIATE GROUP

Provider Business Mailing Address
First Line	:	5868 WESTHEIMER RD #453
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-9998
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 RICHMOND AVE
Second Line	:	SUITE 210 D
City	:	HOUSTON
State	:	TX
Zip	:	77057-9998
Country	:	US
Telephone Number	:	832-370-7266
Fax Number	:	713-975-8005

Authorized Official
Title or Position	:	ATTORNEY-IN-FACT
Name	:	CHASITY LANDRY
Credential	:
Telephone Number	:	832-370-7266

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	06/06/2012

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Directions to “HSCC AFFILIATE GROUP ” Practice Location

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