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NPI Code Detail

MEDICARE: ENDIA W BLADE CRT

MEDICARE: ENDIA W BLADE CRT
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
12278C0205XCritical Care Certified Respiratory Therapist53899TX

General Provider Information

NPI Number : 1942387469
Entity Type Code : Individual
Provider Name (Legal Business Name) : ENDIA W BLADE CRT
Provider Business Mailing Address
First Line : 4027 BROWNSTONE LN
Second Line :
City : HOUSTON
State : TX
Zip : 77053-1406
Country : US
Telephone Number : 713-434-2026
Fax Number :
Provider Business Practice Location Address
First Line : 2002 HOLCOMBE BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77030-4211
Country : US
Telephone Number : 713-794-7313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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