Provider Demographics
NPI:1427595313
Name:TEXAS CHILDRENS HOSPITAL
Entity Type:Organization
Organization Name:TEXAS CHILDRENS HOSPITAL
Other - Org Name:PEDIATRIC PATHOLOGY CONSULTANTS
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/LEAD DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VERSALOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:936-267-5000
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1907
Mailing Address - Country:US
Mailing Address - Phone:936-267-5000
Mailing Address - Fax:
Practice Address - Street 1:17600 INTERSTATE 45 S
Practice Address - Street 2:STE WL0270
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4193
Practice Address - Country:US
Practice Address - Phone:936-267-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Multi-Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematologyGroup - Multi-Specialty
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathologyGroup - Multi-Specialty
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Multi-Specialty
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric PathologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Multi-Specialty