Provider Demographics
NPI:1194964767
Name:MEMORIAL PEDIATRICS
Entity type:Organization
Organization Name:MEMORIAL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROMMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-484-6060
Mailing Address - Street 1:13630 BEAMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6069
Mailing Address - Country:US
Mailing Address - Phone:281-484-6060
Mailing Address - Fax:281-484-6064
Practice Address - Street 1:4024 BROOKHAVEN AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1902
Practice Address - Country:US
Practice Address - Phone:713-944-2324
Practice Address - Fax:713-944-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7977208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111822602Medicaid
TX111822604Medicaid
TX149430401Medicaid
TX111822601Medicaid