Provider Demographics
NPI:1215023882
Name:HOUSTON NORTHWEST PRIMARY CARE PA
Entity Type:Organization
Organization Name:HOUSTON NORTHWEST PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR & MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:281-580-7004
Mailing Address - Street 1:15655 CYPRESS WOODS MEDICAL DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014
Mailing Address - Country:US
Mailing Address - Phone:281-580-7004
Mailing Address - Fax:281-921-1167
Practice Address - Street 1:15655 CYPESS WOODS MEDICAL DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014
Practice Address - Country:US
Practice Address - Phone:281-580-7004
Practice Address - Fax:281-921-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
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
00824NMedicare ID - Type Unspecified