Provider Demographics
NPI:1588466858
Name:MOUNT PEDIATRIC AND FAMILY CLINIC LLC
Entity type:Organization
Organization Name:MOUNT PEDIATRIC AND FAMILY CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:462-938-7873
Mailing Address - Street 1:902 NORMANDY ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-4952
Mailing Address - Country:US
Mailing Address - Phone:462-938-7873
Mailing Address - Fax:462-938-7833
Practice Address - Street 1:902 NORMANDY ST
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4952
Practice Address - Country:US
Practice Address - Phone:462-938-7873
Practice Address - Fax:462-938-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty