Provider Demographics
NPI:1649575721
Name:CENTER FOR PRIMARY CARE & INTEGRATIVE MEDICINE PLLC
Entity Type:Organization
Organization Name:CENTER FOR PRIMARY CARE & INTEGRATIVE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:JINPING
Authorized Official - Middle Name:
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-405-5167
Mailing Address - Street 1:2217 NAOMI ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3823
Mailing Address - Country:US
Mailing Address - Phone:832-405-5167
Mailing Address - Fax:
Practice Address - Street 1:17115 RED OAK DR STE 218
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2607
Practice Address - Country:US
Practice Address - Phone:281-866-0073
Practice Address - Fax:281-866-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty