Healthcare Provider Details

I. General information

NPI: 1083156905
Provider Name (Legal Business Name): PEDIATRIC IMMEDIATE CARE OF TEXAS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 E LEAGUE CITY PKWY SUITE A
LEAGUE CITY TX
77573-7155
US

IV. Provider business mailing address

3831 E LEAGUE CITY PKWY SUITE A
LEAGUE CITY TX
77573-7155
US

V. Phone/Fax

Practice location:
  • Phone: 281-515-2643
  • 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
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number
License Number State

VIII. Authorized Official

Name: RAMI SUNALLAH
Title or Position: OWNER
Credential: MD
Phone: 281-515-2643