MEDICARE: ERICKSON HEALTH MEDICAL GROUP OF TEXAS, PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6444410002	OTHER	TX	DME

General Provider Information

NPI Number	:	1861706558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERICKSON HEALTH MEDICAL GROUP OF TEXAS, PA

Provider Business Mailing Address
First Line	:	5525 RESEARCH PARK DR
Second Line	:	4TH FLOOR
City	:	BALTIMORE
State	:	MD
Zip	:	21228-4664
Country	:	US
Telephone Number	:	281-249-7100
Fax Number	:	281-249-7365

Provider Business Practice Location Address
First Line	:	14703 EAGLE VISTA DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-5394
Country	:	US
Telephone Number	:	281-249-7100
Fax Number	:	281-249-7365

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARY A NORMAN
Credential	:	MD
Telephone Number	:	972-232-8080

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	04/21/2015

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