Provider Demographics
NPI:1104022060
Name:THRITY DESAI MD PA
Entity Type:Organization
Organization Name:THRITY DESAI MD PA
Other - Org Name:NORTHWEST PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THRITY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-444-0000
Mailing Address - Street 1:4560 FM 1960 RD W STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4628
Mailing Address - Country:US
Mailing Address - Phone:281-444-0000
Mailing Address - Fax:281-444-6158
Practice Address - Street 1:4560 FM 1960 RD W STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4628
Practice Address - Country:US
Practice Address - Phone:281-444-0000
Practice Address - Fax:281-444-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9088174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1104022060Medicaid
TX1922056183Medicaid
TX1922056183Medicaid