Provider Demographics
NPI:1386364412
Name:PRIVIA MEDICAL GROUP GULF COAST PLLC
Entity type:Organization
Organization Name:PRIVIA MEDICAL GROUP GULF COAST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP RCM MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-512-7613
Mailing Address - Street 1:1200 BINZ ST STE 1490
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6946
Mailing Address - Country:US
Mailing Address - Phone:713-512-7700
Mailing Address - Fax:
Practice Address - Street 1:4303 VICTORY DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7507
Practice Address - Country:US
Practice Address - Phone:512-462-3627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIVIA MEDICAL GROUP GULF COAST, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-30
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care