Provider Demographics
NPI:1225277544
Name:VINATOWN MEDICAL CLINIC
Entity Type:Organization
Organization Name:VINATOWN MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIO
Authorized Official - Middle Name:QT
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-655-9083
Mailing Address - Street 1:1701 B WEBSTER ST.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-5800
Mailing Address - Country:US
Mailing Address - Phone:713-655-9083
Mailing Address - Fax:713-655-1704
Practice Address - Street 1:1701 B WEBSTER ST.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-5800
Practice Address - Country:US
Practice Address - Phone:713-655-9083
Practice Address - Fax:713-655-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1970208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111550301Medicaid
TXE02388Medicare UPIN
TX00EY639Medicare PIN