NPIMap

Organization Active NPI

Rehoboth Medical Center LLC

  • Pediatrics Physician
  • Katy, TX
National Provider Identifier
1255977583
Registry record updated Nov 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
REHOBOTH MEDICAL CENTER LLC
Doing business as
Rehoboth Pediatric Clinic
Practice address
25231 Roesner LN
Katy, TX 77494-5537
Phone
(281) 506-7412
Fax
(281) 530-2882
NPI assigned
Nov 21, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stella Grace Immanuel, MDNPI 1902947120
Title
Medical Director
Phone
(281) 506-7412

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Pediatric Adolescent Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080A0000X

Addresses

Primary practice location

25231 Roesner LN
Katy, TX 77494-5537

Mailing address

25231 Roesner LN
Katy, TX 77494-5537
Phone (281) 506-7412

Other names 1

  • Rehoboth Pediatric Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Rehoboth Medical Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574294400000",
    "number": "1255977583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25231 ROESNER LN",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774945537",
            "telephone_number": "281-506-7412",
            "fax_number": "281-530-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25231 ROESNER LN",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774945537",
            "telephone_number": "281-506-7412",
            "fax_number": "281-530-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REHOBOTH MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-21",
        "last_updated": "2019-11-21",
        "status": "A",
        "authorized_official_last_name": "IMMANUEL",
        "authorized_official_first_name": "STELLA",
        "authorized_official_middle_name": "GRACE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "281-506-7412",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rehoboth Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Katy, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.