1154730729 NPI number — GROW PEDIATRICS AND ADOLESCENT MEDICINE PLLC

Table of content: MISS ALYSSA ELIZABETH HOEPPNER (NPI 1790258838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154730729 NPI number — GROW PEDIATRICS AND ADOLESCENT MEDICINE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GROW PEDIATRICS AND ADOLESCENT MEDICINE 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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154730729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 PHILOMENA ST STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78723-3574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-467-7334
Provider Business Mailing Address Fax Number:
512-467-7335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 PHILOMENA ST STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78723-3574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-467-7334
Provider Business Practice Location Address Fax Number:
512-467-7335
Provider Enumeration Date:
08/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ARREAZA
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
512-467-7334

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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