Provider Demographics
NPI:1124443023
Name:GREEN TRAILS FAMILY PRACTICE, P.A.
Entity type:Organization
Organization Name:GREEN TRAILS FAMILY PRACTICE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:THANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-492-8400
Mailing Address - Street 1:18400 KATY FWY
Mailing Address - Street 2:SUITE 405
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1286
Mailing Address - Country:US
Mailing Address - Phone:281-492-8400
Mailing Address - Fax:281-492-7774
Practice Address - Street 1:18400 KATY FWY
Practice Address - Street 2:SUITE 405
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1286
Practice Address - Country:US
Practice Address - Phone:281-492-8400
Practice Address - Fax:281-492-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00340TMedicare PIN
G49701Medicare UPIN