| Lake Jackson Clinic, P.a. | |
|
101a Parking Way St Lake Jackson TX 77566-5228 | |
| (979) 297-2441 | |
| Not Available |
| Full Name | Lake Jackson Clinic, P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 101a Parking Way St, Lake Jackson, Texas |
| Authorized Official Name and Position | Liem P Bui (PRESIDENT) |
| Authorized Official Contact | 9792972441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Jackson Clinic, P.a. 101a Parking Way St Lake Jackson TX 77566-5228 Ph: () - | Lake Jackson Clinic, P.a. 101a Parking Way St Lake Jackson TX 77566-5228 Ph: (979) 297-2441 |
| NPI Number | 1205830668 |
|---|---|
| Provider Enumeration Date | 06/13/2005 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4789858689 |
|---|---|
| Medicare Enrollment ID | O20111110000320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205830668 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | E6263 (Texas) | Primary |
| Provider Name | Thuy-khanh Ha Bui |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649265372 PECOS PAC ID: 3577725779 Enrollment ID: I20120504000393 |
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