Provider Demographics
NPI:1336594639
Name:MEGERSSA, ISRU
Entity Type:Individual
Prefix:
First Name:ISRU
Middle Name:
Last Name:MEGERSSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 SUGAR CREEK CENTER BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3688
Mailing Address - Country:US
Mailing Address - Phone:517-505-2261
Mailing Address - Fax:
Practice Address - Street 1:77 SUGAR CREEK CENTER BLVD STE 600
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3688
Practice Address - Country:US
Practice Address - Phone:517-505-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care