Provider Demographics
NPI:1285887513
Name:GULFTON MEDICAL CLINIC P.A.
Entity type:Organization
Organization Name:GULFTON MEDICAL CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINH
Authorized Official - Middle Name:QUANG
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-523-0111
Mailing Address - Street 1:6306 GULFTON ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1108
Mailing Address - Country:US
Mailing Address - Phone:713-523-0111
Mailing Address - Fax:713-484-7204
Practice Address - Street 1:6306 GULFTON ST
Practice Address - Street 2:SUITE #101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1108
Practice Address - Country:US
Practice Address - Phone:713-523-0111
Practice Address - Fax:713-484-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5085261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0999997-01Medicaid
TX0999997-01Medicaid