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General NPI Number Information
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NPI Number | 1326324567
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Entity Type | Organization
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Legal Business Name | AIC PRIMARY CARE, PLLC
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 12/29/2017
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Provider Practice Location Address
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Address Line | 2600 FM 1764 SUITE 190
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City | LAMARQUE
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State | TX
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Zip | 77568
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Country | US
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Telephone | 281-886-8964
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Fax | 409-440-8071
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Provider Business Mailing Address
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Address Line | 2600 FM 1764 SUITE 190
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City | LAMARQUE
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State | TX
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Zip | 77568
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Country | US
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Telephone | 281-886-8964
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Fax | 409-440-8071
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Authorized Official
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Title or Position | CREDENTIALING CONTACT
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Name | MEGAN EACHO JEFFERSON
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Credential |
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Telephone | 281-886-8964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | M4126
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License Number State | TX
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