Healthcare Provider Details

I. General information

NPI: 1396385142
Provider Name (Legal Business Name): TCH PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W 39TH 1/2 ST
AUSTIN TX
78756-3902
US

IV. Provider business mailing address

8080 N STADIUM DR STE 200
HOUSTON TX
77054-1877
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-4545
  • Fax:
Mailing address:
  • Phone: 832-824-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA VILLAR
Title or Position: TCP - CBO GOVERNMENT MANAGER
Credential:
Phone: 832-824-6631