Provider Demographics
NPI:1336351386
Name:TCH PEDIATRIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:TCH PEDIATRIC ASSOCIATES, INC.
Other - Org Name:TCP KINGSLAND
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVIDER RELATIONS REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-824-6611
Mailing Address - Street 1:PO BOX 841969
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21715 KINGSLAND BLVD
Practice Address - Street 2:SUITE # 103
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2543
Practice Address - Country:US
Practice Address - Phone:281-398-7353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty