Provider Demographics
NPI:1164493326
Name:PRIMARY, PREVENTATIVE & PALLIATIVE CARE SPECIALISTS
Entity Type:Organization
Organization Name:PRIMARY, PREVENTATIVE & PALLIATIVE CARE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-938-1770
Mailing Address - Street 1:6807 EMMETT LOWRY EXPRESSWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-2500
Mailing Address - Country:US
Mailing Address - Phone:409-938-1770
Mailing Address - Fax:409-938-0701
Practice Address - Street 1:6807 EMMETT LOWRY EXPRESSWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2543
Practice Address - Country:US
Practice Address - Phone:409-938-1770
Practice Address - Fax:409-938-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0066AEMedicare ID - Type Unspecified