Provider Demographics
NPI:1134322233
Name:NORTHERN PINES HEALTH PARTNERS PA
Entity Type:Organization
Organization Name:NORTHERN PINES HEALTH PARTNERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NGUYEN
Authorized Official - Middle Name:DUC
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-376-2200
Mailing Address - Street 1:8515 SPRING CYPRESS RD
Mailing Address - Street 2:SUITE #108
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3354
Mailing Address - Country:US
Mailing Address - Phone:281-376-2200
Mailing Address - Fax:281-376-2205
Practice Address - Street 1:8515 SPRING CYPRESS RD
Practice Address - Street 2:#108
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3354
Practice Address - Country:US
Practice Address - Phone:281-376-2200
Practice Address - Fax:281-376-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6312207Q00000X
TXL9848207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI18006Medicare UPIN
TX00W941Medicare ID - Type Unspecified