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General NPI Number Information
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NPI Number | 1780997247
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Entity Type | Organization
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Legal Business Name | SOUTHWEST MEDICAL CLINIC
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 11570 BELLAIRE BLVD
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City | HOUSTON
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State | TX
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Zip | 77072-2448
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Country | US
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Telephone | 713-542-3664
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Fax |
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Provider Business Mailing Address
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Address Line | 11570 BELLAIRE BLVD
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City | HOUSTON
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State | TX
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Zip | 77072-2448
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Country | US
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Telephone | 713-542-3664
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOC TAN NGUYEN
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Credential | M.D
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Telephone | 713-542-3664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 801287765
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License Number State | TX
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