Provider Demographics
NPI:1952793036
Name:QUALITY PEDIATRIC ACUTE CARE MEDICAL GROUP
Entity Type:Organization
Organization Name:QUALITY PEDIATRIC ACUTE CARE MEDICAL GROUP
Other - Org Name:QPAC MG
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EZEQUIEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:281-468-8143
Mailing Address - Street 1:9002 CHIMNEY ROCK RD
Mailing Address - Street 2:STE G, #326
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-2509
Mailing Address - Country:US
Mailing Address - Phone:281-468-8143
Mailing Address - Fax:
Practice Address - Street 1:7600 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1906
Practice Address - Country:US
Practice Address - Phone:713-790-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2770208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092566103Medicaid
TX092566103Medicaid