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General NPI Number Information
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NPI Number | 1114477445
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Entity Type | Organization
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Legal Business Name | PRIME MEDIC NETWORK, PLLC
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 211 S COLLEGE AVE
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City | CLEVELAND
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State | TX
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Zip | 77327-4503
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Country | US
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Telephone | 281-592-8622
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Fax | 281-592-8699
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Provider Business Mailing Address
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Address Line | PO BOX 5999
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City | KINGWOOD
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State | TX
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Zip | 77325-5999
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Country | US
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Telephone | 281-592-8622
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Fax | 281-592-8699
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Authorized Official
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Title or Position | OWNER
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Name | SREENIVASULU CHERLO
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Credential | MD
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Telephone | 281-592-8622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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