Organization
CENTER FOR PRIMARY CARE SPECIALISTS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL HULETT (BILLING AND CREDENTIALING)
(409) 933-0733
Entity
Organization
Contact information
Practice address
622 HIGHWAY 3, LA MARQUE, TX 77568-5936
(409) 933-0733
(409) 933-9777
Mailing address
PO BOX 1263, DICKINSON, TX 77539-1263
(409) 933-0733
(409) 933-9777
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D2636
TX
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
D2636
TX
213E00000X
Podiatrist
1443
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0053KD
BLUE CROSS BLUE SHIELD
TX
05
—
080803201
—
TX
01
—
DA0825
MEDICARE RAILROAD
TX
Enumeration date
07/11/2006
Last updated
03/16/2015
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