Provider Demographics
NPI:1285859215
Name:PRIMARY HEALTH NETWORK OF SOUTH TEXAS
Entity type:Organization
Organization Name:PRIMARY HEALTH NETWORK OF SOUTH TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-534-0400
Mailing Address - Street 1:1804 FM 646 W
Mailing Address - Street 2:SUITE J
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539
Mailing Address - Country:US
Mailing Address - Phone:281-534-0400
Mailing Address - Fax:281-534-0440
Practice Address - Street 1:1804 FM 646 W
Practice Address - Street 2:SUITE J
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539
Practice Address - Country:US
Practice Address - Phone:281-534-0400
Practice Address - Fax:281-534-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W591Medicare ID - Type UnspecifiedMEDICARE GROUP