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PED453304-32 Texas Children's Hospital (Active)
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Main Details
Name
Texas Children's Hospital
Subdivision Name
Clear Lake Health Center / Asthma/Pulmonary
Type
Children's Hospital
Rural
No
340B ID
PED453304-32
Medicare Provider Number
453304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/17/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/17/2017
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
940 Clear Lake City Blvd
Webster, TX 77598
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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