MEDICARE: THAO T THACH INC

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	174400000X	Specialist	L6667	TX

General Provider Information

NPI Number	:	1134343056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THAO T THACH INC

Provider Business Mailing Address
First Line	:	PO BOX 453187
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75045-3187
Country	:	US
Telephone Number	:	214-703-9700
Fax Number	:	214-703-9811

Provider Business Practice Location Address
First Line	:	325 N SHILOH RD STE 103
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75042-6610
Country	:	US
Telephone Number	:	214-703-9700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THAO THACH
Credential	:	MD
Telephone Number	:	214-703-9700

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	04/07/2010

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Directions to “THAO T THACH INC ” Practice Location

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