MEDICARE: VANGUARD GERIATRICS OF TEXAS INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	684295	TX
2	363LF0000X	Family Nurse Practitioner	546547	TX
3	363LF0000X	Family Nurse Practitioner	256300	TX
4	363LF0000X	Family Nurse Practitioner	790602	TX
5	207R00000X	Internal Medicine Physician		TX
6	207RG0300X	Geriatric Medicine (Internal Medicine) Physician		TX
7	208D00000X	General Practice Physician		TX
8	363LA2200X	Adult Health Nurse Practitioner		TX
9	363LF0000X	Family Nurse Practitioner		TX
10	363LG0600X	Gerontology Nurse Practitioner	607064	TX
11	363LG0600X	Gerontology Nurse Practitioner		TX
12	363LG0600X	Gerontology Nurse Practitioner	702414	TX
13	363LP2300X	Primary Care Nurse Practitioner		TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0021SU	OTHER	TX	BCBS TX
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1801129515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANGUARD GERIATRICS OF TEXAS INC

Provider Business Mailing Address
First Line	:	4660 BEECHNUT ST STE 218
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-1825
Country	:	US
Telephone Number	:	713-521-0006
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 BEECHNUT ST STE 218
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-1825
Country	:	US
Telephone Number	:	713-521-0006
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. EDITH SPOSSEY SAX
Credential	:	MSN RN GNP BC
Telephone Number	:	713-521-0006

Provider Enumeration Date	:	09/13/2009
Last Update Date	:	09/06/2011