| Providence Family Practice Pa | |
|
9798 Bellaire Blvd Suite D Houston TX 77036-3427 | |
| (713) 270-7224 | |
| (713) 270-0084 |
| Full Name | Providence Family Practice Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 9798 Bellaire Blvd, Houston, Texas |
| Authorized Official Name and Position | Khanh N Ngo (PRESIDENT) |
| Authorized Official Contact | 7132707224 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Family Practice Pa 9798 Bellaire Blvd Suite D Houston TX 77036-3427 Ph: (713) 270-7224 | Providence Family Practice Pa 9798 Bellaire Blvd Suite D Houston TX 77036-3427 Ph: (713) 270-7224 |
| NPI Number | 1255300612 |
|---|---|
| Provider Enumeration Date | 03/16/2006 |
| Last Update Date | 10/25/2007 |
| Medicare PECOS PAC ID | 3173569886 |
|---|---|
| Medicare Enrollment ID | O20050705000397 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255300612 | NPI | - | NPPES |
| Z4078R6 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Susan Thanh Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629039573 PECOS PAC ID: 4880630508 Enrollment ID: I20100805001003 |
| Provider Name | Khanh Ngoc Ngo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245299841 PECOS PAC ID: 0244276954 Enrollment ID: I20100908000430 |
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