Provider Demographics
NPI:1205552452
Name:PRIMARY AND PALLIATIVE HEALTHCARE OF EAST TEXAS,PLLC
Entity type:Organization
Organization Name:PRIMARY AND PALLIATIVE HEALTHCARE OF EAST TEXAS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-933-1003
Mailing Address - Street 1:8901 E F LOWRY EXPWY
Mailing Address - Street 2:STE A
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591
Mailing Address - Country:US
Mailing Address - Phone:409-933-1003
Mailing Address - Fax:409-935-0542
Practice Address - Street 1:8901 E F LOWRY EXPWY
Practice Address - Street 2:STE. A
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591
Practice Address - Country:US
Practice Address - Phone:409-933-1003
Practice Address - Fax:409-935-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty