=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528090107
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAYNE PEDIATRICS, LTD, L.L.P.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1213 HERMANN DR STE 770
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77004-7031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-522-2500
-----------------------------------------------------
Fax | 713-529-2897
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1213 HERMANN DR STE 770
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77004-7031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-522-2500
-----------------------------------------------------
Fax | 713-529-2897
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DR. MARGARET LEE PAYNE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-522-2500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | G1747
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------