Provider Demographics
NPI:1710025010
Name:MEMORIAL-SPRING BRANCH NEONATOLOGY CONSULTANTS, P.A.
Entity Type:Organization
Organization Name:MEMORIAL-SPRING BRANCH NEONATOLOGY CONSULTANTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:POOVAMMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BADUVAMANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-412-2494
Mailing Address - Street 1:PO BOX 975190
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-5190
Mailing Address - Country:US
Mailing Address - Phone:281-412-2494
Mailing Address - Fax:281-412-2495
Practice Address - Street 1:14027 MEMORIAL DR # 252
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6826
Practice Address - Country:US
Practice Address - Phone:281-412-2494
Practice Address - Fax:281-412-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2080N0001X
TXH55962080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G75PMedicare PIN