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General NPI Number Information
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NPI Number | 1881073492
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Entity Type | Organization
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Legal Business Name | ADDISON HOME VISITS MHT LLC
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 05/28/2015
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Provider Practice Location Address
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Address Line | 1515 HERITAGE DR SUITE 110
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City | MCKINNEY
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State | TX
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Zip | 75069-3256
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Country | US
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Telephone | 972-616-4932
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Fax | 877-489-3949
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Provider Business Mailing Address
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Address Line | 1515 HERITAGE DR SUITE 110
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City | MCKINNEY
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State | TX
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Zip | 75069-3256
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Country | US
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Telephone | 972-616-4932
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Fax | 877-489-3949
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | QUYNH TON-THAT
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Credential | MD
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Telephone | 214-529-5989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K2810
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License Number State | TX
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