1841233194 NPI number — PRIMARY HEALTH NETWORK OF SOUTH TEXAS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841233194 NPI number — PRIMARY HEALTH NETWORK OF SOUTH TEXAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY HEALTH NETWORK OF SOUTH TEXAS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841233194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 403856
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-373-7600
Provider Business Mailing Address Fax Number:
615-373-7651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1804 FM 646 RD W
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
DICKINSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77539-3232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-534-0400
Provider Business Practice Location Address Fax Number:
281-534-0440
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
713-383-9605

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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