NPIMap

Organization Active NPI

Privia Medical Group West Texas, PLLC

  • Specialist
  • Abilene, TX
National Provider Identifier
1497755235
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PRIVIA MEDICAL GROUP WEST TEXAS, PLLC
Practice address
1665 Antilley Rd
Suite 200
Abilene, TX 79606-5265
Phone
(325) 437-8655
Fax
(325) 437-8647
NPI assigned
Jul 22, 2005
Last updated
Apr 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andrew Kouba
Title
Ceo/Authorized Official
Phone
(325) 437-8645

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

1665 Antilley Rd
Suite 200
Abilene, TX 79606-5265

Mailing address

PO Box 5409
Abilene, TX 79608-5409
Phone (325) 437-8655

Other names 1

  • Anethesia & CRNA Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Northside Temp4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1497755235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5409",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796085409",
            "telephone_number": "325-437-8655",
            "fax_number": "325-437-8647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 ANTILLEY RD",
            "address_2": "SUITE 200",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796065265",
            "telephone_number": "325-437-8655",
            "fax_number": "325-437-8647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP WEST TEXAS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "KOUBA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CEO/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "325-437-8645"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anethesia & CRNA Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Abilene, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.