Provider Demographics
NPI:1699342261
Name:PRIME HOSPITALIST PARTNERS, LLC
Entity type:Organization
Organization Name:PRIME HOSPITALIST PARTNERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-291-1855
Mailing Address - Street 1:17516 US HIGHWAY 59 STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-8718
Mailing Address - Country:US
Mailing Address - Phone:832-478-0200
Mailing Address - Fax:832-376-7509
Practice Address - Street 1:17516 US HIGHWAY 59 STE 110
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-8718
Practice Address - Country:US
Practice Address - Phone:832-478-0200
Practice Address - Fax:832-376-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188605302Medicaid
TX1994827865OtherTRICARE SOUTH
TX8CJ367OtherBCBSTX