Healthcare Provider Details

I. General information

NPI: 1275013955
Provider Name (Legal Business Name): CHILDREN'S HEALTH PM URGENT CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 09/07/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 HWY 121
THE COLONY TX
75056-2601
US

IV. Provider business mailing address

1 HOLLOW LN
NEW HYDE PARK NY
11042-1220
US

V. Phone/Fax

Practice location:
  • Phone: 214-488-5437
  • Fax: 214-488-5438
Mailing address:
  • Phone: 516-869-0650
  • Fax: 516-673-9408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARLENA SIMPSON
Title or Position: SR. DIRECTOR, CRED & ENROLLMENT
Credential: CPMSM
Phone: 516-207-7851