Provider Demographics
NPI:1295041820
Name:TEXAS PEDIATRIC CLINIC
Entity Type:Organization
Organization Name:TEXAS PEDIATRIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-444-0000
Mailing Address - Street 1:4560 FM 1960 RD W
Mailing Address - Street 2:STE 102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4627
Mailing Address - Country:US
Mailing Address - Phone:281-444-1600
Mailing Address - Fax:281-444-6158
Practice Address - Street 1:4560 FM 1960 RD W
Practice Address - Street 2:STE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4627
Practice Address - Country:US
Practice Address - Phone:281-444-1600
Practice Address - Fax:281-444-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6682261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174243901Medicaid
I31052Medicare UPIN