Basic Information
| Provider Information | |||||||||
| NPI: | 1396385142 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TCH PEDIATRICS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TCP CAPITAL PEDIATRICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8080 N STADIUM DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770541877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328242999 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1100 W 39TH 1/2 ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787563902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124544545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2020 | ||||||||
| LastUpdateDate: | 01/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | VILLAR | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | TCP - CBO GOVERNMENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8328246631 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.