MEDICARE: MGB MINISTRY

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	347C00000X	Private Vehicle
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1902107808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MGB MINISTRY

Provider Business Mailing Address
First Line	:	1930 FERGUS PARK CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-7524
Country	:	US
Telephone Number	:	713-434-7664
Fax Number	:	713-807-9082

Provider Business Practice Location Address
First Line	:	1930 FERGUS PARK CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-7524
Country	:	US
Telephone Number	:	713-434-7664
Fax Number	:	713-807-9082

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL GERHARD BURNS
Credential	:
Telephone Number	:	713-434-7664

Provider Enumeration Date	:	11/09/2010
Last Update Date	:	11/09/2010

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Directions to “MGB MINISTRY ” Practice Location

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