| Mason Park Medical Clinic | |
|
21770 Kingsland Blvd Katy TX 77450-2513 | |
| (281) 646-0740 | |
| (281) 646-0743 |
| Full Name | Mason Park Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 21770 Kingsland Blvd, Katy, Texas |
| Authorized Official Name and Position | Quyen Trinh (CEO) |
| Authorized Official Contact | 2816460740 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mason Park Medical Clinic 21770 Kingsland Blvd Katy TX 77450-2513 Ph: (281) 646-0740 | Mason Park Medical Clinic 21770 Kingsland Blvd Katy TX 77450-2513 Ph: (281) 646-0740 |
| NPI Number | 1053592949 |
|---|---|
| Provider Enumeration Date | 11/19/2007 |
| Last Update Date | 12/12/2022 |
| Medicare PECOS PAC ID | 0345303095 |
|---|---|
| Medicare Enrollment ID | O20190919000286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053592949 | NPI | - | NPPES |
| 140922901 | Medicaid | TX | |
| 130856101 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | J6776 (Texas) | Primary |
| Provider Name | Quyen Trinh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033205224 PECOS PAC ID: 5092601633 Enrollment ID: I20040223000393 |
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