Organization
PRIVIA MEDICAL GROUP GULF COAST, PLLC
Active
Other names
Shine Foot and Ankle Center, Privia Medical Group Gulf Coast, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA JORDAN (ASSOCIATE VP, REVENUE CYCLE)
(713) 512-7613
Entity
Organization
Contact information
Practice address
11614 FM 2244 RD STE 150, AUSTIN, TX 78738-5471
(512) 399-5711
(512) 339-5707
Mailing address
1200 BINZ ST STE 1490, HOUSTON, TX 77004-6946
(713) 512-7700
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Enumeration date
02/19/2021
Last updated
02/19/2021
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