Provider Demographics
NPI:1073674206
Name:PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUDOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-644-1568
Mailing Address - Street 1:4501 GROVEWAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087
Mailing Address - Country:US
Mailing Address - Phone:713-644-1568
Mailing Address - Fax:713-644-1864
Practice Address - Street 1:4501 GROVEWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087
Practice Address - Country:US
Practice Address - Phone:713-644-1568
Practice Address - Fax:713-644-1864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121131002Medicaid
TX00M924OtherBCBS
TX121131004OtherMEDICADE