Provider Demographics
NPI:1689804049
Name:PEDIATRIC URGENT CARE
Entity Type:Organization
Organization Name:PEDIATRIC URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDHWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-232-9772
Mailing Address - Street 1:17510 W GRAND PKWY S
Mailing Address - Street 2:STE 410
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2645
Mailing Address - Country:US
Mailing Address - Phone:281-232-9772
Mailing Address - Fax:281-232-3885
Practice Address - Street 1:19875 SOUTHWEST FWY
Practice Address - Street 2:STE 100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6534
Practice Address - Country:US
Practice Address - Phone:281-545-2323
Practice Address - Fax:281-232-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty