Provider Demographics
NPI:1134901960
Name:PRIVIA MEDICAL GROUP GULF COAST PLLC
Entity type:Organization
Organization Name:PRIVIA MEDICAL GROUP GULF COAST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:VP
Authorized Official - Phone:713-512-7613
Mailing Address - Street 1:1200 BINZ ST STE 1490
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6946
Mailing Address - Country:US
Mailing Address - Phone:713-512-7700
Mailing Address - Fax:832-767-1744
Practice Address - Street 1:3201 UNIVERSITY DR E STE 245
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3483
Practice Address - Country:US
Practice Address - Phone:979-731-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty