| Tri Pham MD LLC | |
|
8650 Millicent Way Shreveport LA 71115 | |
| (318) 642-8128 | |
| Not Available |
| Full Name | Tri Pham MD LLC |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 8650 Millicent Way, Shreveport, Louisiana |
| Authorized Official Name and Position | Tri Hung Pham (OWNER) |
| Authorized Official Contact | 3186176708 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri Pham MD LLC 8703 Glenmora Dr Shreveport LA 71106-6234 Ph: (318) 617-6708 | Tri Pham MD LLC 8650 Millicent Way Shreveport LA 71115 Ph: (318) 642-8128 |
| NPI Number | 1366109621 |
|---|---|
| Provider Enumeration Date | 11/22/2021 |
| Last Update Date | 08/06/2026 |
| Certification Date | 08/06/2026 |
| Medicare PECOS PAC ID | 8224420120 |
|---|---|
| Medicare Enrollment ID | O20220503001236 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366109621 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (NU) | Primary |
| Provider Name | Tri H Pham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952628802 PECOS PAC ID: 3678716107 Enrollment ID: I20130830000304 |
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