Provider Demographics
NPI:1841318987
Name:FAMILYCARE PEDIATRIC P.A
Entity type:Organization
Organization Name:FAMILYCARE PEDIATRIC P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-933-7900
Mailing Address - Street 1:12060 BELLAIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2569
Mailing Address - Country:US
Mailing Address - Phone:281-933-7900
Mailing Address - Fax:281-933-7999
Practice Address - Street 1:12060 BELLAIRE BLVD STE D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2569
Practice Address - Country:US
Practice Address - Phone:281-933-7900
Practice Address - Fax:281-933-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000228Y4Medicare UPIN