Provider Demographics
NPI:1487192316
Name:PRIME MEDIC NETWORK PLLC
Entity Type:Organization
Organization Name:PRIME MEDIC NETWORK PLLC
Other - Org Name:PRIME MEDIC URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SREENIVASULU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-592-8522
Mailing Address - Street 1:19701 KINGWOOD DR
Mailing Address - Street 2:BLDG 10
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3773
Mailing Address - Country:US
Mailing Address - Phone:281-592-8622
Mailing Address - Fax:
Practice Address - Street 1:19701 KINGWOOD DR
Practice Address - Street 2:BLDG 10
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3773
Practice Address - Country:US
Practice Address - Phone:281-592-8622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-12
Last Update Date:2017-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111766506Medicaid
TX8A94814Medicare PIN