Organization Name: | AIC PRIMARY CARE, PLLC |
NPI Number: | 1326324567 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MEGAN EACHO JEFFERSON (CREDENTIALING CONTACT) |
Mailing Address: | 2600 Fm 1764 Suite 190 Lamarque |
State: | TX US |
Postal Code: | 77568 |
Phone Number: | 2818868964 |
Fax Number: | 4094408071 |
NPI Enumeration Date: | 11/02/2011 |
NPI Last Update Date: | 04/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | M4126 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |