MEDICARE: ALL HEALTHCARE MEDICAL CLINIC PLLC

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	208D00000X	General Practice Physician	K8667	TX

General Provider Information

NPI Number	:	1740685494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL HEALTHCARE MEDICAL CLINIC PLLC

Provider Business Mailing Address
First Line	:	1413 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-6614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-6614
Country	:	US
Telephone Number	:	817-831-0034
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BAO VINH NGUYEN-PHUC
Credential	:	MD
Telephone Number	:	817-831-0034

Provider Enumeration Date	:	10/23/2014
Last Update Date	:	10/23/2014

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