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General NPI Number Information
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NPI Number | 1902052251
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Entity Type | Organization
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Legal Business Name | PRIMECARE MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 929 GESSNER RD STE 2450
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City | HOUSTON
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State | TX
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Zip | 77024-2515
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Country | US
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Telephone | 713-464-9939
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Fax | 713-464-9942
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Provider Business Mailing Address
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Address Line | 929 GESSNER STE 2450
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City | HOUSTON
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State | TX
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Zip | 77024-2314
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Country | US
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Telephone | 713-464-9939
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Fax | 713-464-9942
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | LAURA SHILTS
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Credential |
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Telephone | 713-464-9939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | K4677
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License Number State | TX
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