Provider Demographics
NPI:1740266485
Name:PRIMARY HEALTH NETWORK OF SOUTH TEXAS
Entity type:Organization
Organization Name:PRIMARY HEALTH NETWORK OF SOUTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-852-1550
Mailing Address - Street 1:7400 FANNIN ST
Mailing Address - Street 2:SUITE 650
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1920
Mailing Address - Country:US
Mailing Address - Phone:713-864-4414
Mailing Address - Fax:713-864-4412
Practice Address - Street 1:7400 FANNIN ST
Practice Address - Street 2:SUITE 650
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1920
Practice Address - Country:US
Practice Address - Phone:713-864-4414
Practice Address - Fax:713-864-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1740266485Medicaid
TX178023102Medicaid
TX178023109Medicaid
TX178023101Medicaid
TX178023104Medicaid
TX178023103Medicaid
DE6553Medicare PIN
TX1740266485Medicaid
TX178023102Medicaid
TX178023109Medicaid