Provider Demographics
NPI:1114049244
Name:WEST HOUSTON PEDIATRIC ASSOC PA
Entity Type:Organization
Organization Name:WEST HOUSTON PEDIATRIC ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-496-7093
Mailing Address - Street 1:12606 WEST HOUSTON CENTER BLVD
Mailing Address - Street 2:STE 280
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2760
Mailing Address - Country:US
Mailing Address - Phone:281-496-7093
Mailing Address - Fax:281-496-1538
Practice Address - Street 1:12606 WEST HOUSTON CENTER BLVD
Practice Address - Street 2:STE 280
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2760
Practice Address - Country:US
Practice Address - Phone:281-496-7093
Practice Address - Fax:281-496-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0883208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E28665Medicare UPIN