MEDICARE: PRIMARY CARE ASSOCIATES

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	207Q00000X	Family Medicine Physician	J2180	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J2180	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1548391030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE ASSOCIATES

Provider Business Mailing Address
First Line	:	4536 HIGHWAY 6 N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-3402
Country	:	US
Telephone Number	:	281-550-9005
Fax Number	:	208-550-8700

Provider Business Practice Location Address
First Line	:	4536 HIGHWAY 6 N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-3402
Country	:	US
Telephone Number	:	281-550-9005
Fax Number	:	208-550-8700

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. KAREN DIANE MANESS
Credential	:	MD
Telephone Number	:	281-550-9005

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	12/14/2007

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Directions to “PRIMARY CARE ASSOCIATES ” Practice Location

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