MEDICARE: LAURA MURPHY FERTAK PAC

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	363AS0400X	Surgical Physician Assistant	PA00454	TX
2	363A00000X	Physician Assistant	PA00454	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00369474	OTHER	TX	MEDICARE RAILROAD
7	P01170506	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	616771101	OTHER		US DEPT OF LABOR
3	616771105	OTHER		US DEPT OF LABOR
4	1982604658	OTHER	TX	BLUE CROSS BLUE SHIELD
5	8Y0159	OTHER	TX	BCBS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	601771109	OTHER		US DEPT OF LABOR
10	616771110	OTHER		US DEPT OF LABOR
11	86N043	OTHER		BCBSTX

General Provider Information

NPI Number	:	1982604658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MURPHY FERTAK PAC

Provider Business Mailing Address
First Line	:	6550 FANNIN ST
Second Line	:	SUITE 2600
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-441-3595
Fax Number	:	713-793-7107

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST
Second Line	:	SUITE 2600
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-441-3595
Fax Number	:	713-793-7107

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	02/17/2017

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