MEDICARE: MEMORIAL-SPRING BRANCH NEONATOLOGY CONSULTANTS, 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	2080N0001X	Neonatal-Perinatal Medicine Physician
2	2080N0001X	Neonatal-Perinatal Medicine Physician	H5596	TX

General Provider Information

NPI Number	:	1710025010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL-SPRING BRANCH NEONATOLOGY CONSULTANTS, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 975190
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75397-5190
Country	:	US
Telephone Number	:	281-412-2494
Fax Number	:	281-412-2495

Provider Business Practice Location Address
First Line	:	14027 MEMORIAL DR # 252
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-6826
Country	:	US
Telephone Number	:	281-412-2494
Fax Number	:	281-412-2495

Authorized Official
Title or Position	:	PARTNER
Name	:	POOVAMMA M BADUVAMANDA
Credential	:	M.D.
Telephone Number	:	281-412-2494

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	02/07/2011

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