Provider Demographics
NPI:1861426033
Name:CENTER FOR PRIMARY CARE SPECIALISTS, P.A.
Entity type:Organization
Organization Name:CENTER FOR PRIMARY CARE SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:HULETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-933-0733
Mailing Address - Street 1:PO BOX 1263
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-1263
Mailing Address - Country:US
Mailing Address - Phone:409-933-0733
Mailing Address - Fax:409-933-9777
Practice Address - Street 1:622 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-5936
Practice Address - Country:US
Practice Address - Phone:409-933-0733
Practice Address - Fax:409-933-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2636207RG0300X, 207R00000X
TX1443213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0053KDOtherBLUE CROSS BLUE SHIELD
TXDA0825OtherMEDICARE RAILROAD
TX080803201Medicaid
TX=========OtherEIN NUMBER
TX=========OtherEIN NUMBER