Provider Demographics
NPI:1821454539
Name:SAPHIRE PRIMARY CARE ASSOCIATES
Entity Type:Organization
Organization Name:SAPHIRE PRIMARY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHEBA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPPACHAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:281-786-4359
Mailing Address - Street 1:3206 LONGHORN CIR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3270
Mailing Address - Country:US
Mailing Address - Phone:281-786-4359
Mailing Address - Fax:281-994-7154
Practice Address - Street 1:788 NORMANDY ST STE F
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3656
Practice Address - Country:US
Practice Address - Phone:281-786-4359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123576261Q00000X, 261QH0100X, 261QM1300X, 261QP2300X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No305S00000XManaged Care OrganizationsPoint of Service