Provider Demographics
NPI:1497868293
Name:PATRICK KWAN M D P A
Entity Type:Organization
Organization Name:PATRICK KWAN M D P A
Other - Org Name:RED RIVER MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:K
Authorized Official - Last Name:KWAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:940-665-0683
Mailing Address - Street 1:801 N GRAND AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-3574
Mailing Address - Country:US
Mailing Address - Phone:940-665-0683
Mailing Address - Fax:940-668-2663
Practice Address - Street 1:801 N GRAND AVE
Practice Address - Street 2:STE 4
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-3574
Practice Address - Country:US
Practice Address - Phone:940-665-0683
Practice Address - Fax:940-668-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2415261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0050PUOtherBC/BS
TX063665601Medicaid
TX106022OtherCHIP SUPERIOR
TXB24175Medicare UPIN
TX0050PUOtherBC/BS
TX063665601Medicaid