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General NPI Number Information
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NPI Number | 1861426033
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Entity Type | Organization
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Legal Business Name | CENTER FOR PRIMARY CARE SPECIALISTS, P.A.
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 622 HIGHWAY 3
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City | LA MARQUE
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State | TX
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Zip | 77568-5936
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Country | US
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Telephone | 409-933-0733
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Fax | 409-933-9777
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Provider Business Mailing Address
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Address Line | PO BOX 1263
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City | DICKINSON
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State | TX
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Zip | 77539-1263
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Country | US
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Telephone | 409-933-0733
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Fax | 409-933-9777
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Authorized Official
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Title or Position | BILLING AND CREDENTIALING
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Name | CAROL HULETT
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Credential |
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Telephone | 409-933-0733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | D2636
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1443
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D2636
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License Number State | TX
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