Provider Demographics
NPI:1861850158
Name:ELDRIDGE POINTE PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:ELDRIDGE POINTE PEDIATRICS, PLLC
Other - Org Name:ELDRIDGE POINTE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:ANHTHAO
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-274-5689
Mailing Address - Street 1:126 ELDRIDGE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478
Mailing Address - Country:US
Mailing Address - Phone:832-939-8956
Mailing Address - Fax:832-930-4748
Practice Address - Street 1:126 ELDRIDGE RD
Practice Address - Street 2:SUITE D
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:832-939-8956
Practice Address - Fax:832-930-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL8861OtherSTATE LICENSE