Provider Demographics
NPI:1609047687
Name:HOUSTON PEDIATRIC SPECIALTY GROUP PLLC
Entity type:Organization
Organization Name:HOUSTON PEDIATRIC SPECIALTY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-852-1550
Mailing Address - Street 1:7400 FANNIN ST
Mailing Address - Street 2:1130
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1920
Mailing Address - Country:US
Mailing Address - Phone:713-852-1570
Mailing Address - Fax:866-457-4168
Practice Address - Street 1:7400 FANNIN ST
Practice Address - Street 2:1130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1920
Practice Address - Country:US
Practice Address - Phone:713-852-1570
Practice Address - Fax:866-457-4168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2009-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198391801Medicaid
TX00Z314Medicare PIN