Provider Demographics
NPI:1912351974
Name:CHILDRENS SPECIALTY CARE CLINIC
Entity Type:Organization
Organization Name:CHILDRENS SPECIALTY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAIFUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-931-3448
Mailing Address - Street 1:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-1176
Mailing Address - Country:US
Mailing Address - Phone:936-931-3448
Mailing Address - Fax:936-931-3704
Practice Address - Street 1:2312 TIDWELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-6731
Practice Address - Country:US
Practice Address - Phone:713-559-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty