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NPI Code Detail

MEDICARE: PROVIDENCE FAMILY PRACTICE PA

MEDICARE: PROVIDENCE FAMILY PRACTICE PA
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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255300612
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE FAMILY PRACTICE PA
Provider Business Mailing Address
First Line : 9798 BELLAIRE BLVD
Second Line : SUITE D
City : HOUSTON
State : TX
Zip : 77036-3427
Country : US
Telephone Number : 713-270-7224
Fax Number : 713-270-0084
Provider Business Practice Location Address
First Line : 9798 BELLAIRE BLVD
Second Line : SUITE D
City : HOUSTON
State : TX
Zip : 77036-3427
Country : US
Telephone Number : 713-270-7224
Fax Number : 713-270-0084
Authorized Official
Title or Position : PRESIDENT
Name : KHANH N NGO
Credential : DO
Telephone Number : 713-270-7224
Provider Enumeration Date : 03/16/2006
Last Update Date : 10/25/2007

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Directions to “PROVIDENCE FAMILY PRACTICE PA ” Practice Location

Language Start Address Practice Location
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