Provider Demographics
NPI:1477874790
Name:VINH NGUYEN, MD, PA
Entity Type:Organization
Organization Name:VINH NGUYEN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINH
Authorized Official - Middle Name:H
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-349-2891
Mailing Address - Street 1:6915 STONEHENGE RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8924
Mailing Address - Country:US
Mailing Address - Phone:432-349-2891
Mailing Address - Fax:
Practice Address - Street 1:420 E 6TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4529
Practice Address - Country:US
Practice Address - Phone:432-582-8998
Practice Address - Fax:432-582-8997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3770208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212367101OtherPA MEDICAID
TX160635208Medicaid
TX1952308934OtherNPI TYPE 1 ENTITY
TX212367102OtherPA MEDICAID THSTEPS
TX212367102OtherPA MEDICAID THSTEPS