MEDICARE: INGRID EUPHEMIA WEAVER

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	261QH0700X	Hearing and Speech Clinic/Center	103056	TX

General Provider Information

NPI Number	:	1841468931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INGRID EUPHEMIA WEAVER

Provider Business Mailing Address
First Line	:	PO BOX 3104
Second Line	:
City	:	BAYTOWN
State	:	TX
Zip	:	77522-3104
Country	:	US
Telephone Number	:	832-519-4741
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 MARINA BAY DR
Second Line	:	APT 203 C
City	:	CLEAR LAKE SHORES
State	:	TX
Zip	:	77565-2474
Country	:	US
Telephone Number	:	832-519-4741
Fax Number	:

Authorized Official
Title or Position	:	BILLING
Name	:	MR. VICTOR GUTIERREZ
Credential	:
Telephone Number	:	956-380-3400

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	04/20/2008

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