Provider Demographics
NPI:1649289174
Name:NORTHEAST PRIMARY CARE ASSOCIATES P.A.
Entity type:Organization
Organization Name:NORTHEAST PRIMARY CARE ASSOCIATES P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-548-3627
Mailing Address - Street 1:PO BOX 2316
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77347-2316
Mailing Address - Country:US
Mailing Address - Phone:281-548-3627
Mailing Address - Fax:281-548-3660
Practice Address - Street 1:8901 FM 1960 BYPASS W.
Practice Address - Street 2:SUITE 201
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4025
Practice Address - Country:US
Practice Address - Phone:281-548-3627
Practice Address - Fax:281-548-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079552801Medicaid
TX0033CPOtherBCBS GROUP NUMBER
TX079552801Medicaid
TX00011KMedicare ID - Type UnspecifiedGROUP NUMBER