Provider Demographics
NPI:1457502304
Name:PEDIATRIC HOSPITALIST OF CONROE PLLC
Entity Type:Organization
Organization Name:PEDIATRIC HOSPITALIST OF CONROE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-852-1500
Mailing Address - Street 1:500 MEDICAL CENTER BLVD
Mailing Address - Street 2:STE.# 300
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2889
Mailing Address - Country:US
Mailing Address - Phone:936-539-5000
Mailing Address - Fax:936-539-5027
Practice Address - Street 1:500 MEDICAL CENTER BLVD
Practice Address - Street 2:STE.# 300
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2889
Practice Address - Country:US
Practice Address - Phone:936-539-5000
Practice Address - Fax:936-539-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198415501Medicaid
TX198415501Medicaid