Provider Demographics
NPI:1083752059
Name:PEDIATRIC HEALTHCARE OF NORTHWEST HOUSTON PA
Entity Type:Organization
Organization Name:PEDIATRIC HEALTHCARE OF NORTHWEST HOUSTON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TASNEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:PALANPURWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-664-2152
Mailing Address - Street 1:11840 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3840
Mailing Address - Country:US
Mailing Address - Phone:832-912-7044
Mailing Address - Fax:832-912-7033
Practice Address - Street 1:12015 LOUETTA RD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1148
Practice Address - Country:US
Practice Address - Phone:281-664-2152
Practice Address - Fax:281-257-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1134124779OtherNPI
G86571OtherUPIN
1386611721OtherNPI
1396715132OtherNPI
I53967OtherUPIN
1184172462OtherNPI
TX159509205Medicaid
1780651133OtherNPI
TX178813504Medicaid
1063452548OtherNPI
TX1841389897OtherNPI
TX035826904Medicaid
TX130902308Medicaid
1578701439OtherNPI
TX160185803Medicaid
TX128256808Medicaid
1295737286OtherNPI
1710354907OtherNPI
TX194471202Medicaid
1992772990OtherNPI
H26244OtherUPIN
E77616Medicare UPIN