MEDICARE: TRAN MEDICAL CLINIC LLC

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	261QP2300X	Primary Care Clinic/Center	23532	LA

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	:	1992705198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAN MEDICAL CLINIC LLC

Provider Business Mailing Address
First Line	:	365 W HICKORY AVE
Second Line	:
City	:	BASTROP
State	:	LA
Zip	:	71220-4441
Country	:	US
Telephone Number	:	318-283-5999
Fax Number	:	318-283-7998

Provider Business Practice Location Address
First Line	:	365 W HICKORY AVE
Second Line	:
City	:	BASTROP
State	:	LA
Zip	:	71220-4441
Country	:	US
Telephone Number	:	318-283-5999
Fax Number	:	318-283-7998

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDY V TRAN
Credential	:	M.D.
Telephone Number	:	318-283-5999

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	08/22/2020

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Directions to “TRAN MEDICAL CLINIC LLC ” Practice Location

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