Provider Demographics
NPI:1982651410
Name:MEDCARE PEDIATRIC THERAPY, LP
Entity Type:Organization
Organization Name:MEDCARE PEDIATRIC THERAPY, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO - ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINKADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-779-9300
Mailing Address - Street 1:12371 S KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2836
Mailing Address - Country:US
Mailing Address - Phone:713-779-9300
Mailing Address - Fax:713-779-9600
Practice Address - Street 1:12371 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2836
Practice Address - Country:US
Practice Address - Phone:713-779-9300
Practice Address - Fax:713-779-9600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDCARE PEDIATRIC GROUP, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010414251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010414OtherHOME & COMMUNITY SUPPORT SERVICES - LHH CATEGORY - PEDIATRICS
TX180155701Medicaid