Provider Demographics
NPI:1124115308
Name:PREMIER NW HOUSTON MEDICAL GROUP, PA
Entity type:Organization
Organization Name:PREMIER NW HOUSTON MEDICAL GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-758-1022
Mailing Address - Street 1:PO BOX 691524
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-1524
Mailing Address - Country:US
Mailing Address - Phone:281-758-1022
Mailing Address - Fax:281-758-1032
Practice Address - Street 1:7025 FRY RD STE 500
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-8150
Practice Address - Country:US
Practice Address - Phone:281-758-1022
Practice Address - Fax:281-758-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI40494Medicare UPIN