Provider Demographics
NPI:1871592097
Name:SOUTHWEST DOCTORS PA
Entity type:Organization
Organization Name:SOUTHWEST DOCTORS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN SERVICES SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-522-7002
Mailing Address - Street 1:8303 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1600
Mailing Address - Country:US
Mailing Address - Phone:713-522-7002
Mailing Address - Fax:713-528-3351
Practice Address - Street 1:8303 SOUTHWEST FWY
Practice Address - Street 2:SUITE 125
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1600
Practice Address - Country:US
Practice Address - Phone:713-522-7002
Practice Address - Fax:713-528-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00864RMedicare ID - Type Unspecified