Healthcare Provider Details

I. General information

NPI: 1760162341
Provider Name (Legal Business Name): TCH PEDIATRIC ASSOICATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 S FM 1626 SUITE 100
KYLE TX
78640
US

IV. Provider business mailing address

2040 COLQUITT ST
HOUSTON TX
77098-3479
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-2999
  • Fax:
Mailing address:
  • Phone: 832-824-6631
  • 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: 832-824-6631