Provider Demographics
NPI:1184822470
Name:MID-CITIES ARTHRITIS CLINIC, PA
Entity Type:Organization
Organization Name:MID-CITIES ARTHRITIS CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THUAN
Authorized Official - Middle Name:QUANG
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-358-0100
Mailing Address - Street 1:1260 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4244
Mailing Address - Country:US
Mailing Address - Phone:817-358-0100
Mailing Address - Fax:817-358-0125
Practice Address - Street 1:1260 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4244
Practice Address - Country:US
Practice Address - Phone:817-358-0100
Practice Address - Fax:817-358-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-07
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8412207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDG3981OtherMEDICARE RAILROAD
TXF05365Medicare UPIN
TX00T64UMedicare PIN