Provider Demographics
NPI:1619404795
Name:CENTRIC PHYSICIANS GULF REGION PLLC
Entity Type:Organization
Organization Name:CENTRIC PHYSICIANS GULF REGION PLLC
Other - Org Name:CENTRIC PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-267-4575
Mailing Address - Street 1:113 PLEASANT VALLEY DR STE 210
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5683
Mailing Address - Country:US
Mailing Address - Phone:830-267-4575
Mailing Address - Fax:
Practice Address - Street 1:113 PLEASANT VALLEY DR STE 210
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-5683
Practice Address - Country:US
Practice Address - Phone:830-267-4575
Practice Address - Fax:830-267-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-19
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty