Provider Demographics
NPI: | 1306407325 |
---|---|
Name: | MEDCARE PEDIATRIC REHAB CENTER, LP |
Entity Type: | Organization |
Organization Name: | MEDCARE PEDIATRIC REHAB CENTER, LP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PAIGE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KINKADE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 713-995-9292 |
Mailing Address - Street 1: | 12371 S KIRKWOOD RD |
Mailing Address - Street 2: | |
Mailing Address - City: | STAFFORD |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77477-2836 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 713-995-9292 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 12371 S KIRKWOOD RD |
Practice Address - Street 2: | |
Practice Address - City: | STAFFORD |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77477-2836 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-995-9292 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-06-21 |
Last Update Date: | 2019-06-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty |