=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467458059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEXAS MEDICAL&WELLNESS CLINIC P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2005
-----------------------------------------------------
Last Update Date | 09/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6242 N NAVARRO ST
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77904-1705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-551-2288
-----------------------------------------------------
Fax | 361-576-9355
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6242 N NAVARRO ST
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77904-1705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-551-2288
-----------------------------------------------------
Fax | 361-576-9355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NHI P LE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 361-551-2288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | K9105
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | K9105
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------