Healthcare Provider Details

I. General information

NPI: 1588332019
Provider Name (Legal Business Name): TCH PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 GASTON PLACE DRIVE
AUSTIN TX
78733
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 832-824-2999
  • Fax: 832-825-8901
Mailing address:
  • Phone: 832-824-6631
  • 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: MANAGER
Credential:
Phone: 832-824-6631