Provider Demographics
NPI:1417172446
Name:PRIMARY HEALTH NETWORK OF SOUTH TEXAS
Entity Type:Organization
Organization Name:PRIMARY HEALTH NETWORK OF SOUTH TEXAS
Other - Org Name:OMER FAROOQ MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-325-0022
Mailing Address - Street 1:15200 SOUTHWEST FREEWAY
Mailing Address - Street 2:SUITE 295
Mailing Address - City:SUGARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478
Mailing Address - Country:US
Mailing Address - Phone:281-325-0022
Mailing Address - Fax:281-325-0033
Practice Address - Street 1:15200 SOUTHWEST FREEWAY
Practice Address - Street 2:SUITE 295
Practice Address - City:SUGARLAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:281-325-0022
Practice Address - Fax:281-325-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDE6553OtherRR MEDICARE
TXDE6553OtherRR MEDICARE