Provider Demographics
NPI:1932201514
Name:ULTIMATE PEDIATRIC CARE, INC.
Entity type:Organization
Organization Name:ULTIMATE PEDIATRIC CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-271-9010
Mailing Address - Street 1:1001 S DAIRY ASHFORD RD STE 320
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2846
Mailing Address - Country:US
Mailing Address - Phone:713-271-9010
Mailing Address - Fax:713-271-0843
Practice Address - Street 1:1001 S DAIRY ASHFORD RD STE 320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-2846
Practice Address - Country:US
Practice Address - Phone:713-271-9010
Practice Address - Fax:713-271-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008232251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024394101Medicaid
TX001004810OtherPHC
TX001004810OtherPHC