Provider Demographics
NPI:1386220507
Name:PANAMERICANA FAMILY MEDICINE CLINIC PLLC
Entity Type:Organization
Organization Name:PANAMERICANA FAMILY MEDICINE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:ELISA
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-240-1221
Mailing Address - Street 1:9919 NORTH FWY STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-1272
Mailing Address - Country:US
Mailing Address - Phone:346-409-2270
Mailing Address - Fax:281-506-7492
Practice Address - Street 1:9919 NORTH FWY STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-1272
Practice Address - Country:US
Practice Address - Phone:346-409-2270
Practice Address - Fax:281-506-7492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203288008Medicaid