Provider Demographics
NPI:1295974434
Name:PEDIATRIC COTTAGE, P.A.
Entity type:Organization
Organization Name:PEDIATRIC COTTAGE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCCONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-697-3030
Mailing Address - Street 1:7007 NORTH FWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-1324
Mailing Address - Country:US
Mailing Address - Phone:713-697-3030
Mailing Address - Fax:713-697-5678
Practice Address - Street 1:7007 NORTH FWY
Practice Address - Street 2:SUITE 305
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-1324
Practice Address - Country:US
Practice Address - Phone:713-697-3030
Practice Address - Fax:713-697-5678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5376208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10014907OtherAMERIGROUP
TX88160SOtherBCBS
TXE02171Medicare UPIN