=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194964767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEMORIAL PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2009
-----------------------------------------------------
Last Update Date | 02/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4024 BROOKHAVEN AVE
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77504-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-944-2324
-----------------------------------------------------
Fax | 713-944-1539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13630 BEAMER RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77089-6069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-484-6060
-----------------------------------------------------
Fax | 281-484-6064
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. KARIM H. ROMMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 281-484-6060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | F7977
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------