1487162715 NPI number — TYKES TO TEENS PEDIATRICS, PA

Table of content: SAMIRA HAFSA BELHARETH M.D. (NPI 1053508580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487162715 NPI number — TYKES TO TEENS PEDIATRICS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TYKES TO TEENS PEDIATRICS, PA
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:
6
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:
1487162715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5607 AVON LANDING LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-3550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-723-6446
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17510 W GRAND PKWY S STE 580
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-2649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-341-9600
Provider Business Practice Location Address Fax Number:
832-595-2229
Provider Enumeration Date:
01/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
HANH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
832-723-6446

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  K8959 , 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: 030251503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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