1003238056 NPI number — PEDIATRIC ENDOCRINOLOGY OF NORTH TEXAS, PLLC

Table of content: (NPI 1003238056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003238056 NPI number — PEDIATRIC ENDOCRINOLOGY OF NORTH TEXAS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC ENDOCRINOLOGY OF NORTH TEXAS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1003238056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2221 SHAKESPEARE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75010-4930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6124 W PARKER RD
Provider Second Line Business Practice Location Address:
MEDICAL OFFICE BUILDING 3, SUITE #330
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-8122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-600-4861
Provider Business Practice Location Address Fax Number:
940-600-4866
Provider Enumeration Date:
01/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BURTON
Authorized Official First Name:
AMY
Authorized Official Middle Name:
MATHEW
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
940-600-4861

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  N7403 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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