Healthcare Provider Details

I. General information

NPI: 1760888119
Provider Name (Legal Business Name): PEARLAND PEDIATRIC URGENT CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 BROADWAY ST STE A
PEARLAND TX
77581-5501
US

IV. Provider business mailing address

2017 BROADWAY ST STE A
PEARLAND TX
77581-5501
US

V. Phone/Fax

Practice location:
  • Phone: 281-485-9990
  • Fax: 281-485-9469
Mailing address:
  • Phone: 281-485-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. JENNIFER DENISE GRAY
Title or Position: PRESIDENT
Credential: MD
Phone: 281-485-9990