MEDICARE: EASY TECH TUTORING 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	251K00000X	Public Health or Welfare Agency
2	251T00000X	PACE Provider Organization

General Provider Information

NPI Number	:	1841760477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASY TECH TUTORING LLC

Provider Business Mailing Address
First Line	:	2902 BRIARHURST DR APT 909
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5335
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2902 BRIARHURST DR APT 909
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5335
Country	:	US
Telephone Number	:	346-232-5047
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CYBAL A GOODLETTE
Credential	:
Telephone Number	:	346-232-5047

Provider Enumeration Date	:	11/27/2018
Last Update Date	:	11/28/2018

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