MEDICARE: OHTC HEALTH CARE SYSTEM, PLLC

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	284300000X	Special Hospital	AC00007	TX

General Provider Information

NPI Number	:	1871658435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHTC HEALTH CARE SYSTEM, PLLC

Provider Business Mailing Address
First Line	:	2625 OLD DENTON RD
Second Line	:	SUITE 546
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5125
Country	:	US
Telephone Number	:	972-608-8877
Fax Number	:	972-245-8888

Provider Business Practice Location Address
First Line	:	2625 OLD DENTON RD
Second Line	:	SUITE 546
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5125
Country	:	US
Telephone Number	:	972-608-8877
Fax Number	:	972-245-8888

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. EDWARD SONG
Credential	:	L.AC., PH.D
Telephone Number	:	972-608-8877

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	02/12/2010

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