MEDICARE: BERNSTEIN ASSOCIATED MANAGEMENT,LLC

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	291U00000X	Clinical Medical Laboratory	45DO970553	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CLIA 45DO970553	OTHER	TX	MEDICAL LOBORATORY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790848968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNSTEIN ASSOCIATED MANAGEMENT,LLC

Provider Business Mailing Address
First Line	:	4315 LOCKWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-4117
Country	:	US
Telephone Number	:	713-670-0975
Fax Number	:	713-670-0998

Provider Business Practice Location Address
First Line	:	4315 LOCKWOOD DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-4117
Country	:	US
Telephone Number	:	713-670-0975
Fax Number	:	713-670-0998

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. BENNIE FERRELL RUCKER
Credential	:	PHD
Telephone Number	:	713-670-0975

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	08/22/2020

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