MEDICARE: MRS. RUBY JOE LVN

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	164X00000X	Licensed Vocational Nurse	47246	TX

General Provider Information

NPI Number	:	1972727154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUBY JOE LVN

Provider Business Mailing Address
First Line	:	7112 FIELD VIEW LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75249-1112
Country	:	US
Telephone Number	:	972-283-8931
Fax Number	:	817-334-0249

Provider Business Practice Location Address
First Line	:	700 HEMPHILL ST
Second Line	:	SUITE A
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3105
Country	:	US
Telephone Number	:	817-334-0111
Fax Number	:	817-334-0249

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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