MEDICARE: CENTER FOR PRIMARY CARE SPECIALISTS, P.A.

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	D2636	TX
2	213E00000X	Podiatrist	1443	TX
3	207R00000X	Internal Medicine Physician	D2636	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DA0825	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0053KD	OTHER	TX	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861426033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR PRIMARY CARE SPECIALISTS, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 1263
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-1263
Country	:	US
Telephone Number	:	409-933-0733
Fax Number	:	409-933-9777

Provider Business Practice Location Address
First Line	:	622 HIGHWAY 3
Second Line	:
City	:	LA MARQUE
State	:	TX
Zip	:	77568-5936
Country	:	US
Telephone Number	:	409-933-0733
Fax Number	:	409-933-9777

Authorized Official
Title or Position	:	BILLING AND CREDENTIALING
Name	:	CAROL HULETT
Credential	:
Telephone Number	:	409-933-0733

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/16/2015

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Directions to “CENTER FOR PRIMARY CARE SPECIALISTS, P.A. ” Practice Location

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