Provider Demographics
NPI:1205087095
Name:MAINLAND PRIMARY CARE PHYSICIANS, PLLC
Entity type:Organization
Organization Name:MAINLAND PRIMARY CARE PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-852-1500
Mailing Address - Street 1:6807 EMMETT LOWRY EXPRESSWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-6807
Mailing Address - Country:US
Mailing Address - Phone:409-938-1770
Mailing Address - Fax:
Practice Address - Street 1:6807 EMMETT F LOWRY EXPRESSWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-6807
Practice Address - Country:US
Practice Address - Phone:409-938-1770
Practice Address - Fax:409-938-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209785901Medicaid
TXDO7727Medicare PIN
TX0A0132Medicare PIN