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PED453304-05 Texas Children's Hospital (Active)
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Main Details
Name
Texas Children's Hospital
Subdivision Name
Texas Children's Hospital WC Diabetes/Endocrine Clinic
Type
Children's Hospital
Rural
No
340B ID
PED453304-05
Medicare Provider Number
453304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/11/2013
Participating Start Date
10/1/2013
Participating Approval Date
8/28/2013
Last Recertification Date
9/7/2024
Contacts
Authorizing Official
Texas Children's Hospital
Weldon Gage, Executive Vice President/CFO
(832) 826-8084
Primary Contact
Texas Children's Hospital
Jeffrey L. Wagner, Vice President
(832) 824-6091
Addresses
Street Address
18200 Katy Freeway
Houston, TX 77094
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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