Basic Information
| Provider Information | |||||||||
| NPI: | 1083752059 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEDIATRIC HEALTHCARE OF NORTHWEST HOUSTON PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11840 FM 1960 RD W | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770653840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8329127044 | ||||||||
| FaxNumber: | 8329127033 | ||||||||
| Practice Location | |||||||||
| Address1: | 12015 LOUETTA RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770701148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816642152 | ||||||||
| FaxNumber: | 2812573514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | PALANPURWALA | ||||||||
| AuthorizedOfficialFirstName: | TASNEEM | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2816642152 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1134124779 | 01 | TX | NPI | OTHER | G86571 | 01 | UPIN | OTHER | 1386611721 | 01 | NPI | OTHER | 1396715132 | 01 | NPI | OTHER | I53967 | 01 | UPIN | OTHER | 1184172462 | 01 | NPI | OTHER | 159509205 | 05 | TX | MEDICAID | 1780651133 | 01 | NPI | OTHER | 178813504 | 05 | TX | MEDICAID | 1063452548 | 01 | NPI | OTHER | 1841389897 | 01 | TX | NPI | OTHER | 035826904 | 05 | TX | MEDICAID | 130902308 | 05 | TX | MEDICAID | 1578701439 | 01 | NPI | OTHER | 160185803 | 05 | TX | MEDICAID | 128256808 | 05 | TX | MEDICAID | 1295737286 | 01 | NPI | OTHER | 1710354907 | 01 | NPI | OTHER | 194471202 | 05 | TX | MEDICAID | 1992772990 | 01 | NPI | OTHER | H26244 | 01 | UPIN | OTHER |