1962709394 NPI number — WELL CHILD PEDIATRICS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962709394 NPI number — WELL CHILD PEDIATRICS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELL CHILD PEDIATRICS, 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:
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:
1962709394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22703 SHANNON FALLS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77494-2259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-655-8061
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26440 FM 1093 RD
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77406-7201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-333-1062
Provider Business Practice Location Address Fax Number:
281-335-4529
Provider Enumeration Date:
02/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KANCHERLA
Authorized Official First Name:
SHAILAJA
Authorized Official Middle Name:
REDDY
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
919-655-8061

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)





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