Provider Demographics
NPI:1083730444
Name:CHILDREN'S CLINIC OF KATY
Entity Type:Organization
Organization Name:CHILDREN'S CLINIC OF KATY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:CADE
Authorized Official - Last Name:NELMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-829-6860
Mailing Address - Street 1:705 S FRY RD
Mailing Address - Street 2:STE 320
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2251
Mailing Address - Country:US
Mailing Address - Phone:281-829-6860
Mailing Address - Fax:281-829-6863
Practice Address - Street 1:705 S FRY RD
Practice Address - Street 2:STE 320
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2251
Practice Address - Country:US
Practice Address - Phone:281-829-6860
Practice Address - Fax:281-829-6863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9876261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID #