1588332019 NPI number — TCH PEDIATRICS INC

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 1588332019 NPI number — TCH PEDIATRICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TCH PEDIATRICS INC
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:
1588332019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8080 N STADIUM DR STE 200
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:
77054-1877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-824-6631
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1932 GASTON PLACE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-824-2999
Provider Business Practice Location Address Fax Number:
832-825-8901
Provider Enumeration Date:
08/31/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VILLAR
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
832-824-6631

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)