| Qi Wan Md Pc | |
|
333 Whitesport Dr Sw Ste 303 Huntsville AL 35801-3455 | |
| (256) 650-0275 | |
| (256) 881-0468 |
| Full Name | Qi Wan Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 333 Whitesport Dr Sw, Huntsville, Alabama |
| Authorized Official Name and Position | Qi Wan (OWNER) |
| Authorized Official Contact | 2566500275 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Qi Wan Md Pc 333 Whitesport Dr Sw Ste 303 Huntsville AL 35801-3455 Ph: (256) 650-0275 | Qi Wan Md Pc 333 Whitesport Dr Sw Ste 303 Huntsville AL 35801-3455 Ph: (256) 650-0275 |
| NPI Number | 1932141348 |
|---|---|
| Provider Enumeration Date | 06/11/2006 |
| Last Update Date | 02/05/2008 |
| Medicare PECOS PAC ID | 9436142999 |
|---|---|
| Medicare Enrollment ID | O20040408000509 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932141348 | NPI | - | NPPES |
| 51519742 | Other | AL | BCBS OF AL PROVIDER # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 21622 (Alabama) | Primary |
| Provider Name | Qi Wan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750341400 PECOS PAC ID: 8426959669 Enrollment ID: I20040415000291 |
| Provider Name | Chrissy J Gardner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083299085 PECOS PAC ID: 7416345152 Enrollment ID: I20211028002005 |
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