| Tricare Medical Group, Pc | |
|
5985 Columbia Pike Suite 102 Falls Church VA 22041-2043 | |
| (703) 578-0707 | |
| (703) 578-0909 |
| Full Name | Tricare Medical Group, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5985 Columbia Pike, Falls Church, Virginia |
| Authorized Official Name and Position | Tri Pham (PRESIDENT) |
| Authorized Official Contact | 7035780707 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tricare Medical Group, Pc 5985 Columbia Pike Suite 102 Falls Church VA 22041 Ph: (703) 578-0707 | Tricare Medical Group, Pc 5985 Columbia Pike Suite 102 Falls Church VA 22041-2043 Ph: (703) 578-0707 |
| NPI Number | 1417142167 |
|---|---|
| Provider Enumeration Date | 09/06/2007 |
| Last Update Date | 11/10/2011 |
| Medicare PECOS PAC ID | 6800970880 |
|---|---|
| Medicare Enrollment ID | O20080229000077 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417142167 | NPI | - | NPPES |
| 010199620 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 0101235759 (Virginia) | Primary |
| Provider Name | Tri Minh Pham |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831205707 PECOS PAC ID: 6305866534 Enrollment ID: I20051201000849 |
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