Provider Demographics
NPI:1134579303
Name:NORTHSTAR PCP NETWORK, LLC
Entity type:Organization
Organization Name:NORTHSTAR PCP NETWORK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:713-478-3313
Mailing Address - Street 1:4114 SABLEMIST CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2032
Mailing Address - Country:US
Mailing Address - Phone:713-478-3313
Mailing Address - Fax:
Practice Address - Street 1:2918 SAN JACINTO ST
Practice Address - Street 2:SUITE 150
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-2708
Practice Address - Country:US
Practice Address - Phone:734-709-6477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHSTAR PCP NETWORK, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization