Provider Demographics
NPI:1912064924
Name:PEARLAND PRIMARY CARE ASSOCIATES, LLP
Entity Type:Organization
Organization Name:PEARLAND PRIMARY CARE ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHENDRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-485-4050
Mailing Address - Street 1:8619 BROADWAY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8782
Mailing Address - Country:US
Mailing Address - Phone:281-485-4050
Mailing Address - Fax:281-485-3553
Practice Address - Street 1:8619 BROADWAY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8782
Practice Address - Country:US
Practice Address - Phone:281-485-4050
Practice Address - Fax:281-485-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149925301Medicaid
TX149925301Medicaid