Provider Demographics
NPI:1134313158
Name:MEMORIAL PEDIATRICS
Entity Type:Organization
Organization Name:MEMORIAL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:HAB
Authorized Official - Last Name:ROMMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-484-6060
Mailing Address - Street 1:13630 BEAMER RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13630 BEAMER RD
Practice Address - Street 2:SUITE 108
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6069
Practice Address - Country:US
Practice Address - Phone:281-484-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYSHORE PEDIATRICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7977208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1118222601Medicaid
TX1118222602Medicaid