| Fairway Family Medicine-primary Care, Pllc | |
|
4100 Fairway Dr 320 Carrollton TX 75010-6525 | |
| (972) 236-7608 | |
| Not Available |
| Full Name | Fairway Family Medicine-primary Care, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4100 Fairway Dr, Carrollton, Texas |
| Authorized Official Name and Position | Hong Xiao (MEDICAL DIRECTOR) |
| Authorized Official Contact | 4698789480 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairway Family Medicine-primary Care, Pllc 4100 Fairway Dr 320 Carrollton TX 75010-6525 Ph: (972) 236-7608 | Fairway Family Medicine-primary Care, Pllc 4100 Fairway Dr 320 Carrollton TX 75010-6525 Ph: (972) 236-7608 |
| NPI Number | 1508115718 |
|---|---|
| Provider Enumeration Date | 09/04/2012 |
| Last Update Date | 09/04/2012 |
| Medicare PECOS PAC ID | 2264689827 |
|---|---|
| Medicare Enrollment ID | O20120904000606 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508115718 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | L3196 (Texas) | Primary |
| Provider Name | Thuc-nguyen V Tran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114995305 PECOS PAC ID: 4385779313 Enrollment ID: I20100316000930 |
| Provider Name | Hong Xiao |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669434601 PECOS PAC ID: 3274661533 Enrollment ID: I20100506000377 |
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