Healthcare Provider Details

I. General information

NPI: 1881530251
Provider Name (Legal Business Name): PEDS CARE 4 ALL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 N 23RD ST
BEAUMONT TX
77706-2902
US

IV. Provider business mailing address

1570 N 23RD ST
BEAUMONT TX
77706-2902
US

V. Phone/Fax

Practice location:
  • Phone: 630-995-9290
  • Fax: 773-337-9133
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: JORGE W BLACK
Title or Position: PRESIDENT
Credential: MD
Phone: 630-995-9290