Healthcare Provider Details

I. General information

NPI: 1659008266
Provider Name (Legal Business Name): TCH PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13917 W HWY 71 STE A
AUSTIN TX
78738-3008
US

IV. Provider business mailing address

2040 COLQUITT ST APT A
HOUSTON TX
77098-3480
US

V. Phone/Fax

Practice location:
  • Phone: 512-610-7030
  • Fax:
Mailing address:
  • Phone:
  • 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: 832-824-2999