Provider Demographics
NPI:1952439283
Name:VIP PEDIATRICS, P.A.
Entity type:Organization
Organization Name:VIP PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEOFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOLENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-665-4567
Mailing Address - Street 1:2727 GRAMERCY ST
Mailing Address - Street 2:SUITE #225
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1617
Mailing Address - Country:US
Mailing Address - Phone:713-665-4567
Mailing Address - Fax:713-665-8962
Practice Address - Street 1:2727 GRAMERCY ST
Practice Address - Street 2:SUITE #225
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1617
Practice Address - Country:US
Practice Address - Phone:713-665-4567
Practice Address - Fax:713-665-8962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3536208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG65448Medicare UPIN
TX00W311Medicare ID - Type Unspecified