MEDICARE: ELIHU WATTS OPA-C, 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	246ZX2200X	Orthopedic Assistant

General Provider Information

NPI Number	:	1720486509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIHU WATTS OPA-C, CSFA

Provider Business Mailing Address
First Line	:	472 HILLCREST RD
Second Line	:
City	:	MOUNTVILLE
State	:	SC
Zip	:	29370-3816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 SPURS LN STE 245
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1689
Country	:	US
Telephone Number	:	210-487-7468
Fax Number	:

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

Provider Enumeration Date	:	12/10/2014
Last Update Date	:	12/10/2014

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