Provider Demographics
NPI:1912663196
Name:NIGHT LIGHT AFTER HOURS PEDIATRICS CYFAIR PA
Entity Type:Organization
Organization Name:NIGHT LIGHT AFTER HOURS PEDIATRICS CYFAIR PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-957-2020
Mailing Address - Street 1:PO BOX 123337
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-3337
Mailing Address - Country:US
Mailing Address - Phone:713-957-2020
Mailing Address - Fax:
Practice Address - Street 1:19708 NORTHWEST FWY STE 500
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77065-5626
Practice Address - Country:US
Practice Address - Phone:713-957-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care