Provider Demographics
NPI:1801374806
Name:TEENS AND TOTS PEDIATRIC CARE PLLC
Entity Type:Organization
Organization Name:TEENS AND TOTS PEDIATRIC CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WINIFRED
Authorized Official - Middle Name:NANCY
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-998-7367
Mailing Address - Street 1:19 POPLAR PINE COURT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3693
Mailing Address - Country:US
Mailing Address - Phone:832-998-7367
Mailing Address - Fax:
Practice Address - Street 1:17115 RED OAK DRIVE
Practice Address - Street 2:SUITE 113
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2603
Practice Address - Country:US
Practice Address - Phone:832-998-7367
Practice Address - Fax:713-472-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2316208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3562811Medicaid