MEDICARE: M.T.N. PHARM. CORPORATION

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1225304025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.T.N. PHARM. CORPORATION

Provider Business Mailing Address
First Line	:	9798 BELLAIRE BLVD STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3428
Country	:	US
Telephone Number	:	713-995-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	9798 BELLAIRE BLVD STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3428
Country	:	US
Telephone Number	:	713-995-8885
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TOM THAIHOC NGUYEN
Credential	:
Telephone Number	:	713-628-8538

Provider Enumeration Date	:	03/26/2012
Last Update Date	:	03/26/2012

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