Provider Demographics
NPI:1871926428
Name:CHILDREN 1ST HOUSTON SOUTH, LLC
Entity type:Organization
Organization Name:CHILDREN 1ST HOUSTON SOUTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-340-1840
Mailing Address - Street 1:9709 LAKESIDE BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1213
Mailing Address - Country:US
Mailing Address - Phone:713-489-2198
Mailing Address - Fax:713-489-2978
Practice Address - Street 1:8545 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017
Practice Address - Country:US
Practice Address - Phone:214-412-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL ASC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-19
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical