MEDICARE: 1 BODY MED SPA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	261QC1500X	Community Health Clinic/Center
3	261QI0500X	Infusion Therapy Clinic/Center
4	261QP0904X	Federal Public Health Clinic/Center
5	261QR0800X	Recovery Care Clinic/Center
6	163W00000X	Registered Nurse

General Provider Information

NPI Number	:	1992581029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1 BODY MED SPA INC

Provider Business Mailing Address
First Line	:	3220 KIRBY DR STE 140
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5549
Country	:	US
Telephone Number	:	317-993-2439
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 KIRBY DR STE 140
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5549
Country	:	US
Telephone Number	:	317-993-2439
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TURISTA JACKSON
Credential	:
Telephone Number	:	317-993-2439

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	09/05/2023

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