MEDICARE: CHCA MAINLAND, LP

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	261QX0100X	Occupational Medicine Clinic/Center	000793	TX

General Provider Information

NPI Number	:	1881870954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHCA MAINLAND, LP

Provider Business Mailing Address
First Line	:	1125 HIGHWAY 3 N
Second Line	:	SUITE 180
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-4048
Country	:	US
Telephone Number	:	409-938-5665
Fax Number	:	409-938-5669

Provider Business Practice Location Address
First Line	:	1125 HIGHWAY 3 N
Second Line	:	SUITE 180
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-4048
Country	:	US
Telephone Number	:	409-938-5665
Fax Number	:	409-938-5669

Authorized Official
Title or Position	:	CFO
Name	:	MR. SCOTT BENTLEY
Credential	:
Telephone Number	:	409-938-5186

Provider Enumeration Date	:	01/18/2008
Last Update Date	:	01/18/2008

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Directions to “CHCA MAINLAND, LP ” Practice Location

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