Provider Demographics
NPI:1114477445
Name:PRIME MEDIC NETWORK, PLLC
Entity Type:Organization
Organization Name:PRIME MEDIC NETWORK, PLLC
Other - Org Name:PRIME MEDIC URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SREENIVASULU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-592-8622
Mailing Address - Street 1:PO BOX 5999
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77325-5999
Mailing Address - Country:US
Mailing Address - Phone:281-592-8622
Mailing Address - Fax:281-592-8699
Practice Address - Street 1:211 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4503
Practice Address - Country:US
Practice Address - Phone:281-592-8622
Practice Address - Fax:281-592-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111766506Medicaid