MEDICARE: GREAT KIDS PEDIATRICS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0065KP	OTHER	TX	BLUE CROSS BLUE SHIELD TX

General Provider Information

NPI Number	:	1770542458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT KIDS PEDIATRICS

Provider Business Mailing Address
First Line	:	915 GESSNER RD STE 350
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2539
Country	:	US
Telephone Number	:	713-932-6261
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 GESSNER RD
Second Line	:	SUITE 350
City	:	HOUSTON
State	:	TX
Zip	:	77024-2527
Country	:	US
Telephone Number	:	713-932-6261
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JENNIFER ROBINSON
Credential	:
Telephone Number	:	713-932-6261

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	06/04/2026

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Directions to “GREAT KIDS PEDIATRICS ” Practice Location

Language	Start Address	Practice Location

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