Provider Demographics
NPI:1457736563
Name:SILVERLAKE PEDIATRIC CLINC
Entity Type:Organization
Organization Name:SILVERLAKE PEDIATRIC CLINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PNP
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:GARY
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:713-436-3637
Mailing Address - Street 1:9721 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8169
Mailing Address - Country:US
Mailing Address - Phone:713-436-3637
Mailing Address - Fax:
Practice Address - Street 1:9721 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8169
Practice Address - Country:US
Practice Address - Phone:713-436-3637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125437261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care