Basic Information
| Provider Information | |||||||||
| NPI: | 1073070207 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEDIATRIC URGENT CARE OF TEXAS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7918 BROADWAY ST STE 108 | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775817930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818576171 | ||||||||
| FaxNumber: | 2817832117 | ||||||||
| Practice Location | |||||||||
| Address1: | 508 THIS WAY ST | ||||||||
| Address2: | |||||||||
| City: | LAKE JACKSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775665128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797055007 | ||||||||
| FaxNumber: | 2817832117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2019 | ||||||||
| LastUpdateDate: | 02/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | ALBITAR | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMAD | ||||||||
| AuthorizedOfficialMiddleName: | FARES | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2818576171 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.