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Organization
PRIVIA MEDICAL GROUP GULF COAST, PLLC
Active
Organization
PRIVIA MEDICAL GROUP GULF COAST, PLLC
Active
Other names
University Pain
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA JORDAN (DELEGATED OFFICIAL)
(713) 512-7613
Entity
Organization
Contact information
Practice address
9305 PINECROFT DR STE 104, THE WOODLANDS, TX 77380-3482
(281) 896-0013
(281) 896-0014
Mailing address
1200 BINZ ST STE 1490, HOUSTON, TX 77004-6946
(713) 512-7252
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7803750001
MEDICARE DME
TX
Enumeration date
03/26/2020
Last updated
04/13/2020
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