1144424995 NPI number — HEALTHY KIDS PEDIATRICS

Table of content: (NPI 1144424995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144424995 NPI number — HEALTHY KIDS PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHY KIDS PEDIATRICS
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144424995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4851 LEGACY DR
Provider Second Line Business Mailing Address:
SUITE 601
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-0816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-294-0808
Provider Business Mailing Address Fax Number:
972-294-0809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4851 LEGACY DR
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-0816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-294-0808
Provider Business Practice Location Address Fax Number:
972-294-0809
Provider Enumeration Date:
06/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAIN
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Z.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-294-0808

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  J6315 , 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)

  • Identifier: 1083700314 . This is a "DR. BAIN'S INDIVIDUAL NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com