Provider Demographics
NPI:1619954799
Name:ATASCOCITA PRIMARY CARE, PA
Entity Type:Organization
Organization Name:ATASCOCITA PRIMARY CARE, PA
Other - Org Name:ATASCOCITA PRIMARY CARE, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUONG
Authorized Official - Middle Name:QUYNH
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-852-9500
Mailing Address - Street 1:18700 W LAKE HOUSTON PKWY
Mailing Address - Street 2:STE A104
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3349
Mailing Address - Country:US
Mailing Address - Phone:281-852-9500
Mailing Address - Fax:281-852-9755
Practice Address - Street 1:18700 W LAKE HOUSTON PKWY
Practice Address - Street 2:STE A104
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3349
Practice Address - Country:US
Practice Address - Phone:281-852-9500
Practice Address - Fax:281-852-9755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5556261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDE2075OtherMEDICARE RAILROAD
TX0099MYOtherBCBS
TX0099MYOtherBCBS