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General NPI Number Information
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NPI Number | 1063496685
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Entity Type | Organization
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Legal Business Name | PRIMARY HEALTH NETWORK OF SOUTH TEXAS
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8830 LONG POINT RD SUITE 401
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City | HOUSTON
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State | TX
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Zip | 77055-3040
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Country | US
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Telephone | 713-468-2358
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Fax | 713-468-2595
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Provider Business Mailing Address
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Address Line | PO BOX 403856
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City | ATLANTA
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State | GA
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Zip | 30384-0001
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Country | US
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Telephone | 615-373-7600
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. TODD EVANS
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Credential |
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Telephone | 713-468-2358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M0999
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License Number State | TX
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