| Thanh Van DO, M. D., P. A. | |
|
12121 Richmond Ave Suite # 216 Houston TX 77082-2432 | |
| (281) 496-1010 | |
| (281) 599-1506 |
| Full Name | Thanh Van DO, M. D., P. A. |
|---|---|
| Speciality | Clinic/Center |
| Location | 12121 Richmond Ave, Houston, Texas |
| Authorized Official Name and Position | Thanh Van DO (PHYSICIAN/DIRECTOR) |
| Authorized Official Contact | 8325786958 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thanh Van DO, M. D., P. A. 21015 Crystal Greens Dr Katy TX 77450-8650 Ph: (832) 578-6958 | Thanh Van DO, M. D., P. A. 12121 Richmond Ave Suite # 216 Houston TX 77082-2432 Ph: (281) 496-1010 |
| NPI Number | 1487769113 |
|---|---|
| Provider Enumeration Date | 08/21/2006 |
| Last Update Date | 02/09/2015 |
| Medicare PECOS PAC ID | 9830080753 |
|---|---|
| Medicare Enrollment ID | O20040322000834 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487769113 | NPI | - | NPPES |
| 0067KP | Other | TX | BLUE CROSS BLUE SHIELD |
| 1490443-04 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | J5087 (Texas) | Primary |
| Provider Name | Thanh Van DO |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083663033 PECOS PAC ID: 1658262506 Enrollment ID: I20040322001202 |
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