Healthcare Provider Details

I. General information

NPI: 1457502304
Provider Name (Legal Business Name): PEDIATRIC HOSPITALIST OF CONROE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MEDICAL CENTER BLVD STE.# 300
CONROE TX
77304-2889
US

IV. Provider business mailing address

500 MEDICAL CENTER BLVD STE.# 300
CONROE TX
77304-2889
US

V. Phone/Fax

Practice location:
  • Phone: 936-539-5000
  • Fax: 936-539-5027
Mailing address:
  • Phone: 936-539-5000
  • Fax: 936-539-5027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TODD EVANS
Title or Position: PRESIDENT
Credential:
Phone: 713-852-1500