Healthcare Provider Details

I. General information

NPI: 1659404598
Provider Name (Legal Business Name): TCH PEDIATRIC ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/21/2022
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 GASTON PLACE DR.
AUSTIN TX
78733-2658
US

IV. Provider business mailing address

PO BOX 841969
DALLAS TX
75284-1969
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA VILLAR
Title or Position: TCP MANAGER
Credential:
Phone: 832-824-2999