Provider Demographics
NPI:1326324567
Name:AIC PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:AIC PRIMARY CARE, PLLC
Other - Org Name:AFFINITY IMMEDIATE CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:EACHO
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-886-8964
Mailing Address - Street 1:2600 FM 1764
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LAMARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568
Mailing Address - Country:US
Mailing Address - Phone:281-886-8964
Mailing Address - Fax:409-440-8071
Practice Address - Street 1:2600 FM 1764
Practice Address - Street 2:SUITE 190
Practice Address - City:LAMARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568
Practice Address - Country:US
Practice Address - Phone:281-886-8964
Practice Address - Fax:409-440-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4126261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX278947Medicare PIN
TX126646Medicare UPIN