Provider Demographics
NPI:1871795187
Name:SOUTHWEST PRIMARY CARE PA
Entity type:Organization
Organization Name:SOUTHWEST PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIREN
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-980-2233
Mailing Address - Street 1:1235 LAKE POINTE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4077
Mailing Address - Country:US
Mailing Address - Phone:281-980-2233
Mailing Address - Fax:281-980-2220
Practice Address - Street 1:1235 LAKE POINTE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4077
Practice Address - Country:US
Practice Address - Phone:281-980-2233
Practice Address - Fax:281-980-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0082HWOtherBCBS GROUP PROVIDER NUMBE
TX165424601Medicaid
TX00229UMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER