Provider Demographics
NPI:1255337812
Name:PEDIATRIC AND ADOLESCENT CENTER OF NW HOUSTON, P A
Entity type:Organization
Organization Name:PEDIATRIC AND ADOLESCENT CENTER OF NW HOUSTON, P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:POONAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-357-5678
Mailing Address - Street 1:455 SCHOOL ST
Mailing Address - Street 2:STE 26
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4597
Mailing Address - Country:US
Mailing Address - Phone:281-357-5678
Mailing Address - Fax:281-357-8765
Practice Address - Street 1:455 SCHOOL ST
Practice Address - Street 2:STE 26
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4597
Practice Address - Country:US
Practice Address - Phone:281-357-5678
Practice Address - Fax:281-357-8765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160279902OtherTEXAS HEALTH STEPS
TX0002JSOtherBLUE CROSS & BLUE SHIELD
TX160279901Medicaid
TX0002JSOtherBLUE CROSS & BLUE SHIELD