MEDICARE: ENA DENISE COWART KARLSTEN OTIS

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	3416L0300X	Land Ambulance	1000600	TX

General Provider Information

NPI Number	:	1982996476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENA DENISE COWART KARLSTEN OTIS

Provider Business Mailing Address
First Line	:	6040 WESTPARK DR
Second Line	:	UNIT # E004
City	:	HOUSTON
State	:	TX
Zip	:	77057-7533
Country	:	US
Telephone Number	:	832-603-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6040 WESTPARK DR
Second Line	:	UNIT # E004
City	:	HOUSTON
State	:	TX
Zip	:	77057-7533
Country	:	US
Telephone Number	:	832-603-4200
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KENNETH BRUNECKE III
Credential	:
Telephone Number	:	832-603-4200

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	06/07/2012

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