Provider Demographics
NPI: | 1760888119 |
---|---|
Name: | PEARLAND PEDIATRIC URGENT CARE PA |
Entity Type: | Organization |
Organization Name: | PEARLAND PEDIATRIC URGENT CARE PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JENNIFER |
Authorized Official - Middle Name: | DENISE |
Authorized Official - Last Name: | GRAY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 281-485-9990 |
Mailing Address - Street 1: | 2017 BROADWAY ST STE A |
Mailing Address - Street 2: | |
Mailing Address - City: | PEARLAND |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77581-5501 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 281-485-9990 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2017 BROADWAY ST STE A |
Practice Address - Street 2: | |
Practice Address - City: | PEARLAND |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77581-5501 |
Practice Address - Country: | US |
Practice Address - Phone: | 281-485-9990 |
Practice Address - Fax: | 281-485-9469 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-11-12 |
Last Update Date: | 2014-11-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 261QU0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |