Provider Demographics
NPI:1992705198
Name:TRAN MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:TRAN MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:V
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-283-5999
Mailing Address - Street 1:365 W HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-4441
Mailing Address - Country:US
Mailing Address - Phone:318-283-5999
Mailing Address - Fax:318-283-7998
Practice Address - Street 1:365 W HICKORY AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4441
Practice Address - Country:US
Practice Address - Phone:318-283-5999
Practice Address - Fax:318-283-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23532261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1495794Medicaid
LA1495794Medicaid
LA5CD15Medicare ID - Type Unspecified