Provider Demographics
NPI:1801199492
Name:CHILDRENS SPECIALTY CARE CLINIC
Entity Type:Organization
Organization Name:CHILDRENS SPECIALTY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAIFUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-600-0786
Mailing Address - Street 1:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-1176
Mailing Address - Country:US
Mailing Address - Phone:936-931-3448
Mailing Address - Fax:936-931-3704
Practice Address - Street 1:19722 SAUMS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-4734
Practice Address - Country:US
Practice Address - Phone:281-600-0786
Practice Address - Fax:281-600-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty