Provider Demographics
NPI:1841808771
Name:KIDZ PLUS MEDICAL CLINIC
Entity type:Organization
Organization Name:KIDZ PLUS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LONZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-717-2780
Mailing Address - Street 1:PO BOX 9755
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77213-0755
Mailing Address - Country:US
Mailing Address - Phone:832-717-2780
Mailing Address - Fax:832-717-2781
Practice Address - Street 1:5610 BELCREST ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-3040
Practice Address - Country:US
Practice Address - Phone:832-517-5901
Practice Address - Fax:832-717-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX379399401Medicaid