MEDICARE: TCH PEDIATRIC ASSOCIATES, INC

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1740550326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TCH PEDIATRIC ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	PO BOX 841969
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-1969
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9701 N SAM HOUSTON PKWY E
Second Line	:	SUITE 170
City	:	HUMBLE
State	:	TX
Zip	:	77396-4636
Country	:	US
Telephone Number	:	281-441-6900
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER RELATIONS REP
Name	:	MIRIAM COMPTON
Credential	:
Telephone Number	:	832-824-6602

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	01/12/2012

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