MEDICARE: SOUTHWEST 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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0082HW	OTHER	TX	BCBS GROUP PROVIDER NUMBE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871795187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST PRIMARY CARE PA

Provider Business Mailing Address
First Line	:	1235 LAKE POINTE PKWY STE 101
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4077
Country	:	US
Telephone Number	:	281-980-2233
Fax Number	:	281-980-2220

Provider Business Practice Location Address
First Line	:	1235 LAKE POINTE PKWY STE 101
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4077
Country	:	US
Telephone Number	:	281-980-2233
Fax Number	:	281-980-2220

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VIREN N SHAH
Credential	:	MD
Telephone Number	:	281-980-2233

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	11/14/2024

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Directions to “SOUTHWEST PRIMARY CARE PA ” Practice Location

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