Provider Demographics
NPI:1467190421
Name:PRIMARY CARE OF VAN VLECK, PLLC
Entity Type:Organization
Organization Name:PRIMARY CARE OF VAN VLECK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:ATIQ
Authorized Official - Last Name:DADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-245-2421
Mailing Address - Street 1:PO BOX 2660
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77404-2660
Mailing Address - Country:US
Mailing Address - Phone:979-245-2421
Mailing Address - Fax:979-245-6263
Practice Address - Street 1:170 S 4TH ST
Practice Address - Street 2:#2
Practice Address - City:VAN VLECK
Practice Address - State:TX
Practice Address - Zip Code:77482
Practice Address - Country:US
Practice Address - Phone:979-245-2421
Practice Address - Fax:979-245-6263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty