Basic Information
| Provider Information | |||||||||
| NPI: | 1538790613 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TCH PEDIATRICS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8080 N STADIUM DR STE 200 | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770541877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328246631 | ||||||||
| FaxNumber: | 8328258901 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 DUVAL RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787593550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122500220 | ||||||||
| FaxNumber: | 8889650796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2020 | ||||||||
| LastUpdateDate: | 01/28/2020 | ||||||||
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| AuthorizedOfficialLastName: | VILLAR | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | TCP- CBO MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8328246631 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.