Provider Demographics
NPI:1588651681
Name:PEARLAND PEDIATRICS
Entity type:Organization
Organization Name:PEARLAND PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTERBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-485-9990
Mailing Address - Street 1:2017 BROADWAY ST # A
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5501
Mailing Address - Country:US
Mailing Address - Phone:281-485-9990
Mailing Address - Fax:281-485-9469
Practice Address - Street 1:2017 BROADWAY ST # A
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5501
Practice Address - Country:US
Practice Address - Phone:281-485-9990
Practice Address - Fax:281-485-9469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126410303OtherTEXAS PROVIDER IDENDIFIER
TXF25231Medicare UPIN