MEDICARE: PREMIERCARE FAMILY CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	K7844	TX

General Provider Information

NPI Number	:	1124356753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIERCARE FAMILY CLINIC

Provider Business Mailing Address
First Line	:	1010 W BAKER RD
Second Line	:	#102
City	:	BAYTOWN
State	:	TX
Zip	:	77521-2382
Country	:	US
Telephone Number	:	281-428-5755
Fax Number	:	832-556-8667

Provider Business Practice Location Address
First Line	:	1010 W BAKER RD
Second Line	:	#102
City	:	BAYTOWN
State	:	TX
Zip	:	77521-2382
Country	:	US
Telephone Number	:	281-428-5755
Fax Number	:	832-556-8667

Authorized Official
Title or Position	:	MEMBER/OWNER
Name	:	CHRISINA LAM
Credential	:
Telephone Number	:	281-428-5755

Provider Enumeration Date	:	11/19/2009
Last Update Date	:	11/19/2009

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Directions to “PREMIERCARE FAMILY CLINIC ” Practice Location

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