MEDICARE: HOUSTON FERTILITY LABORATORY 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

General Provider Information

NPI Number	:	1811159189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON FERTILITY LABORATORY LLC

Provider Business Mailing Address
First Line	:	2500 FONDREN RD STE 350
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-2315
Country	:	US
Telephone Number	:	713-782-8279
Fax Number	:	713-782-3139

Provider Business Practice Location Address
First Line	:	2500 FONDREN RD STE 350
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-2315
Country	:	US
Telephone Number	:	713-782-8279
Fax Number	:	713-782-3139

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	INDERBIR S GILL
Credential	:	MD
Telephone Number	:	713-782-8279

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	06/27/2008

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