1215139340 NPI number — PEDIATRIC AND ENDOCRINOLOGY PLLC

Table of content: (NPI 1215139340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215139340 NPI number — PEDIATRIC AND ENDOCRINOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC AND ENDOCRINOLOGY PLLC
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:
PEDIATRICS & ENDOCRINOLOGY
Provider Other Organization Name Type Code:
3
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:
1215139340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17115 RED OAK DRIVE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77090-2607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-781-8144
Provider Business Mailing Address Fax Number:
281-781-8853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17115 RED OAK DRIVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77090-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-781-8144
Provider Business Practice Location Address Fax Number:
281-781-8853
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOORTY
Authorized Official First Name:
NAILA
Authorized Official Middle Name:
YUNUS
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
281-781-8144

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0205X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 290275101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1550108 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285638676 . This is a "NPI-TYPE I" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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