Provider Demographics
NPI:1164824199
Name:TCH PEDIATRIC ASSOCIATES, INC
Entity Type:Organization
Organization Name:TCH PEDIATRIC ASSOCIATES, INC
Other - Org Name:TCP GRAND PARKWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-824-6631
Mailing Address - Street 1:1919 S BRAESWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4444
Mailing Address - Country:US
Mailing Address - Phone:832-824-6631
Mailing Address - Fax:
Practice Address - Street 1:7505 MAIN ST STE 450
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4524
Practice Address - Country:US
Practice Address - Phone:832-824-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty