MEDICARE: PEDIATRIC INFECTIOUS DISEASE SPECIALISTS OF HOUSTON, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0208X	Pediatric Infectious Diseases Physician	L3227	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023015013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC INFECTIOUS DISEASE SPECIALISTS OF HOUSTON, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 3278
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77588-3278
Country	:	US
Telephone Number	:	713-464-9776
Fax Number	:	713-646-9771

Provider Business Practice Location Address
First Line	:	1140 BUSINESS CENTER DR.
Second Line	:	#300
City	:	HOUSTON
State	:	TX
Zip	:	77043-2742
Country	:	US
Telephone Number	:	713-464-9776
Fax Number	:	713-464-9771

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RENE ANTHONY AMAYA
Credential	:	M.D.
Telephone Number	:	713-464-9776

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	01/19/2011

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