MEDICARE: WEST BELLFORT PEDIATRIC CLINICS, 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	261QP2300X	Primary Care Clinic/Center	N1405	TX

General Provider Information

NPI Number	:	1730450669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST BELLFORT PEDIATRIC CLINICS, INC.

Provider Business Mailing Address
First Line	:	3631 HANSFORD PL
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-4990
Country	:	US
Telephone Number	:	713-981-6002
Fax Number	:	713-981-7409

Provider Business Practice Location Address
First Line	:	8527 W BELLFORT ST
Second Line	:	#B
City	:	HOUSTON
State	:	TX
Zip	:	77071-2265
Country	:	US
Telephone Number	:	713-981-6002
Fax Number	:	713-981-7409

Authorized Official
Title or Position	:	ADMINISTRATOR/DIRECTOR
Name	:	DR. IFEYINWA PATIENCE ONWUDIWE
Credential	:	MD,
Telephone Number	:	713-981-6002

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	01/24/2012

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