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General NPI Number Information
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NPI Number | 1821454539
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Entity Type | Organization
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Legal Business Name | SAPHIRE PRIMARY CARE ASSOCIATES
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 788 NORMANDY ST STE F
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City | HOUSTON
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State | TX
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Zip | 77015-3656
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Country | US
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Telephone | 281-786-4359
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Fax |
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Provider Business Mailing Address
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Address Line | 3206 LONGHORN CIR
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City | MANVEL
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State | TX
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Zip | 77578-3270
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Country | US
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Telephone | 281-786-4359
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Fax | 281-994-7154
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Authorized Official
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Title or Position | OWNER
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Name | PHEBA PAPPACHAN
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Credential | FNP-C
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Telephone | 281-786-4359
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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 | AP123576
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | AP123576
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | AP123576
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | AP123576
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AP123576
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License Number State | TX
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