MEDICARE: PANAMERICANA FAMILY MEDICINE CLINIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386220507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANAMERICANA FAMILY MEDICINE CLINIC PLLC

Provider Business Mailing Address
First Line	:	9919 NORTH FWY STE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-1272
Country	:	US
Telephone Number	:	346-409-2270
Fax Number	:	281-506-7492

Provider Business Practice Location Address
First Line	:	9919 NORTH FWY STE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-1272
Country	:	US
Telephone Number	:	346-409-2270
Fax Number	:	281-506-7492

Authorized Official
Title or Position	:	CEO
Name	:	CARMEN ELISA VEGA
Credential	:
Telephone Number	:	713-240-1221

Provider Enumeration Date	:	03/18/2021
Last Update Date	:	03/18/2021

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