MEDICARE: DAIRY ASHFORD VERIMED CLINIC INC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1356864862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAIRY ASHFORD VERIMED CLINIC INC

Provider Business Mailing Address
First Line	:	2909 HILLCROFT ST STE 325
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5815
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 S DAIRY ASHFORD RD STE 200B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2319
Country	:	US
Telephone Number	:	281-272-6198
Fax Number	:	281-272-6927

Authorized Official
Title or Position	:	MANAGER
Name	:	HANH NGUYEN
Credential	:
Telephone Number	:	281-272-6198

Provider Enumeration Date	:	07/18/2017
Last Update Date	:	07/18/2017

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