MEDICARE: TEXAS MEDICAL&WELLNESS 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	207Q00000X	Family Medicine Physician	K9105	TX
2	207R00000X	Internal Medicine Physician	K9105	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AD895	OTHER	TX	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467458059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS MEDICAL&WELLNESS CLINIC P.A.

Provider Business Mailing Address
First Line	:	6242 N NAVARRO ST
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-1705
Country	:	US
Telephone Number	:	361-551-2288
Fax Number	:	361-576-9355

Provider Business Practice Location Address
First Line	:	6242 N NAVARRO ST
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-1705
Country	:	US
Telephone Number	:	361-551-2288
Fax Number	:	361-576-9355

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NHI P LE
Credential	:	MD
Telephone Number	:	361-551-2288

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	09/20/2023

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Directions to “TEXAS MEDICAL&WELLNESS CLINIC P.A. ” Practice Location

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