Healthcare Provider Details

I. General information

NPI: 1700106747
Provider Name (Legal Business Name): TCH PEDIATRIC ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24022 CINCO VILLAGE CENTER BLVD SUITE 100
KATY TX
77494-8397
US

IV. Provider business mailing address

8080 N STADIUM DR SUITE 200
HOUSTON TX
77054-1829
US

V. Phone/Fax

Practice location:
  • Phone: 281-391-9696
  • 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: MIRIAM COMPTON
Title or Position: PROVIDER RELATIONS REP
Credential:
Phone: 832-824-6602