MEDICARE: GREATER HOUSTON PRIMARY CARE PA

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	207Q00000X	Family Medicine Physician	K5384	TX

General Provider Information

NPI Number	:	1801976667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER HOUSTON PRIMARY CARE PA

Provider Business Mailing Address
First Line	:	12326 SHADOW GREEN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-5641
Country	:	US
Telephone Number	:	281-589-2334
Fax Number	:	281-589-2867

Provider Business Practice Location Address
First Line	:	12000 RICHMOND AVE
Second Line	:	SUITE 135
City	:	HOUSTON
State	:	TX
Zip	:	77082-2431
Country	:	US
Telephone Number	:	281-589-2334
Fax Number	:	281-589-2867

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SONAL R PATEL
Credential	:
Telephone Number	:	281-589-2334

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	02/13/2012

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