Organization
PRIVIA MEDICAL GROUP GULF COAST PLLC
Active
Other names
Premiere Sports and Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA JORDAN VP (VP, REVENUE CYCLE MANAGEMENT)
(713) 512-7613
Entity
Organization
Contact information
Practice address
3201 UNIVERSITY DR E STE 245, BRYAN, TX 77802-3483
(979) 731-3100
Mailing address
1200 BINZ ST STE 1490, HOUSTON, TX 77004-6946
(713) 512-7700
(832) 767-1744
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Enumeration date
10/17/2023
Last updated
10/17/2023
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