Basic Information
| Provider Information | |||||||||
| NPI: | 1861712804 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TCH PEDIATRIC ASSOCIATES, INC | ||||||||
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| OtherOrganizationName: | TCPA SHADOW CREEK RANCH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8080 N STADIUM DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770541829 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 KIRBY ST | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775845704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135128600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2010 | ||||||||
| LastUpdateDate: | 06/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | COMPTON | ||||||||
| AuthorizedOfficialFirstName: | MIRIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER RELATIONS REP | ||||||||
| AuthorizedOfficialTelephone: | 8328246602 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.