MEDICARE: CHILDRENS SPECIALTY CARE CLINIC

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	207K00000X	Allergy & Immunology Physician
2	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1912351974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDRENS SPECIALTY CARE CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 1176
Second Line	:
City	:	WALLER
State	:	TX
Zip	:	77484-1176
Country	:	US
Telephone Number	:	936-931-3448
Fax Number	:	936-931-3704

Provider Business Practice Location Address
First Line	:	2312 TIDWELL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-6731
Country	:	US
Telephone Number	:	713-559-0786
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAIFUDDIN TAHIR
Credential	:	MD
Telephone Number	:	936-931-3448

Provider Enumeration Date	:	04/15/2016
Last Update Date	:	04/15/2016

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