Provider Demographics
NPI:1215535414
Name:PRIMARY CARE SERVICE EVOLUTION LLC
Entity Type:Organization
Organization Name:PRIMARY CARE SERVICE EVOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-419-4816
Mailing Address - Street 1:1826 WOODED ACRES DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-2991
Mailing Address - Country:US
Mailing Address - Phone:832-419-4816
Mailing Address - Fax:
Practice Address - Street 1:12680 W LAKE HOUSTON PKWY
Practice Address - Street 2:510
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044
Practice Address - Country:US
Practice Address - Phone:866-438-3883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty