MEDICARE: BEN FALLS CP

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	332B00000X	Durable Medical Equipment & Medical Supplies		TX

General Provider Information

NPI Number	:	1831575620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEN FALLS CP

Provider Business Mailing Address
First Line	:	12926 WILLOW CHASE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5641
Country	:	US
Telephone Number	:	281-419-6638
Fax Number	:	281-419-7098

Provider Business Practice Location Address
First Line	:	12926 WILLOW CHASE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5641
Country	:	US
Telephone Number	:	281-419-6638
Fax Number	:	281-419-7098

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

Provider Enumeration Date	:	08/04/2015
Last Update Date	:	08/04/2015

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