Provider Demographics
NPI:1407403264
Name:TCH PEDIATRIC ASSOCIATES, INC
Entity Type:Organization
Organization Name:TCH PEDIATRIC ASSOCIATES, INC
Other - Org Name:TCP LONG HORN PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TCP CBO MANAGER
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 1:8080 N STADIUM DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1877
Mailing Address - Country:US
Mailing Address - Phone:832-824-6631
Mailing Address - Fax:
Practice Address - Street 1:12120 RANCH ROAD 620 N
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1079
Practice Address - Country:US
Practice Address - Phone:512-833-7334
Practice Address - Fax:512-833-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty