MEDICARE: VERSACARD, INC

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	174400000X	Specialist	MDE4831	TX

General Provider Information

NPI Number	:	1770716573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERSACARD, INC

Provider Business Mailing Address
First Line	:	5225 KATY FWY
Second Line	:	SUITE 600
City	:	HOUSTON
State	:	TX
Zip	:	77007-2264
Country	:	US
Telephone Number	:	713-453-8551
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 KATY FWY
Second Line	:	SUITE 600
City	:	HOUSTON
State	:	TX
Zip	:	77007-2264
Country	:	US
Telephone Number	:	713-453-8551
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM FRANCIS DONOVAN
Credential	:	M.D.
Telephone Number	:	713-453-8551

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	08/26/2009

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