MEDICARE: VIP PEDIATRICS, 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	208000000X	Pediatrics Physician	K3536	TX

General Provider Information

NPI Number	:	1952439283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIP PEDIATRICS, P.A.

Provider Business Mailing Address
First Line	:	2727 GRAMERCY ST
Second Line	:	SUITE #225
City	:	HOUSTON
State	:	TX
Zip	:	77025-1617
Country	:	US
Telephone Number	:	713-665-4567
Fax Number	:	713-665-8962

Provider Business Practice Location Address
First Line	:	2727 GRAMERCY ST
Second Line	:	SUITE #225
City	:	HOUSTON
State	:	TX
Zip	:	77025-1617
Country	:	US
Telephone Number	:	713-665-4567
Fax Number	:	713-665-8962

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEOFFREY K. WOLENS
Credential	:	MD
Telephone Number	:	713-665-4567

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/22/2020

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