MEDICARE: 1960 FAMILY PRACTICE, PA

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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

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	:	1578952941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1960 FAMILY PRACTICE, PA

Provider Business Mailing Address
First Line	:	20320 NORTHWEST FWY
Second Line	:	SUITE 500
City	:	JERSEY VILLAGE
State	:	TX
Zip	:	77065-5641
Country	:	US
Telephone Number	:	281-586-3888
Fax Number	:	281-440-2020

Provider Business Practice Location Address
First Line	:	20320 NORTHWEST FWY
Second Line	:	SUITE 900
City	:	JERSEY VILLAGE
State	:	TX
Zip	:	77065-5641
Country	:	US
Telephone Number	:	281-586-3888
Fax Number	:	281-440-2020

Authorized Official
Title or Position	:	OWNER
Name	:	HUONG LE
Credential	:	M.D
Telephone Number	:	281-453-7224

Provider Enumeration Date	:	01/22/2015
Last Update Date	:	01/22/2015

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Directions to “1960 FAMILY PRACTICE, PA ” Practice Location

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