MEDICARE: TCH PEDIATRIC ASSOCIATES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1699095638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TCH PEDIATRIC ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	8080 N STADIUM DR
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77054-1829
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5505 W OREM DR
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77085-1276
Country	:	US
Telephone Number	:	713-283-1039
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER RELATIONS REP
Name	:	MIRIAM COMPTON
Credential	:
Telephone Number	:	832-824-6602

Provider Enumeration Date	:	06/01/2010
Last Update Date	:	06/01/2010

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