Provider Demographics
NPI:1902257793
Name:SIDHUS PRIMARY CARE LLC
Entity Type:Organization
Organization Name:SIDHUS PRIMARY CARE LLC
Other - Org Name:SIDHUS FAMILY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GURNAIB
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-674-8554
Mailing Address - Street 1:4546 HIGHWAY 6 N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3402
Mailing Address - Country:US
Mailing Address - Phone:832-674-8554
Mailing Address - Fax:
Practice Address - Street 1:4546 HIGHWAY 6 N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3402
Practice Address - Country:US
Practice Address - Phone:832-674-8554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7671261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161-990-0032Medicaid