Basic Information
| Provider Information | |||||||||
| NPI: | 1841233194 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIMARY HEALTH NETWORK OF SOUTH TEXAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 403856 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303840001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153737600 | ||||||||
| FaxNumber: | 6153737651 | ||||||||
| Practice Location | |||||||||
| Address1: | 1804 FM 646 RD W | ||||||||
| Address2: | SUITE J | ||||||||
| City: | DICKINSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775393232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815340400 | ||||||||
| FaxNumber: | 2815340440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | EVANS | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7133839605 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.