MEDICARE: GULFTON MEDICAL CLINIC P.A.

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	261Q00000X	Clinic/Center	F5085	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1285887513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULFTON MEDICAL CLINIC P.A.

Provider Business Mailing Address
First Line	:	6306 GULFTON ST
Second Line	:	SUITE #101
City	:	HOUSTON
State	:	TX
Zip	:	77081-1108
Country	:	US
Telephone Number	:	713-523-0111
Fax Number	:	713-484-7204

Provider Business Practice Location Address
First Line	:	6306 GULFTON ST
Second Line	:	SUITE #101
City	:	HOUSTON
State	:	TX
Zip	:	77081-1108
Country	:	US
Telephone Number	:	713-523-0111
Fax Number	:	713-484-7204

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VINH QUANG TRINH
Credential	:	M.D.
Telephone Number	:	713-523-0111

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	10/30/2008

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