1023274487 NPI number — CHILDREN'S DOCTORS

Table of content: (NPI 1023274487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023274487 NPI number — CHILDREN'S DOCTORS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S DOCTORS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023274487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7580 FANNIN ST
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77054-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-807-0029
Provider Business Mailing Address Fax Number:
713-529-4784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7580 FANNIN ST
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77054-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-807-0029
Provider Business Practice Location Address Fax Number:
713-529-4784
Provider Enumeration Date:
08/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VAZIRINIA
Authorized Official First Name:
NEGAR
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
713-807-0029

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  J5658 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 133454205 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 179090908 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133454201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com