1316073240 NPI number — KIDS 'N TEENS CLINICS, P.A.

Table of content: (NPI 1316073240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316073240 NPI number — KIDS 'N TEENS CLINICS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDS 'N TEENS CLINICS, P.A.
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:
1316073240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2925 W T C JESTER BLVD STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77018-7050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-681-7334
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2925 W T C JESTER BLVD STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77018-7050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-448-5437
Provider Business Practice Location Address Fax Number:
281-448-2988
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ISART
Authorized Official First Name:
FERNANDO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-681-7334

Provider Taxonomy Codes

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

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

  • Identifier: 081128304 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 326618102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 325942602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 325942601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 081128301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 326618101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com