Provider Demographics
NPI: | 1831871185 |
---|---|
Name: | SYNERGY PRIMECARE PLLC |
Entity type: | Organization |
Organization Name: | SYNERGY PRIMECARE PLLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHIRLEY |
Authorized Official - Middle Name: | ADAEZE |
Authorized Official - Last Name: | AMANFO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | APRN, FNP-C, MSN |
Authorized Official - Phone: | 281-752-6233 |
Mailing Address - Street 1: | 406 SUMMERSET LANE |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOKSHIRE |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77423 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 281-752-6233 |
Mailing Address - Fax: | 866-635-1388 |
Practice Address - Street 1: | 1331 N GRAND PKWY STE 111 |
Practice Address - Street 2: | |
Practice Address - City: | KATY |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77493-2711 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-717-9249 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-08-07 |
Last Update Date: | 2024-06-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | Group - Single Specialty |