Healthcare Provider Details

I. General information

NPI: 1982254355
Provider Name (Legal Business Name): MEDCARE PEDIATRIC REHAB CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12371 S KIRKWOOD RD
STAFFORD TX
77477-2836
US

IV. Provider business mailing address

12371 S KIRKWOOD RD
STAFFORD TX
77477-2836
US

V. Phone/Fax

Practice location:
  • Phone: 713-773-5100
  • Fax:
Mailing address:
  • Phone: 713-995-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAIGE KINKADE
Title or Position: CEO
Credential:
Phone: 713-995-9292