1376857706 NPI number — ADVANCED KIDS CARE, P.A.

Table of content: (NPI 1376857706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376857706 NPI number — ADVANCED KIDS CARE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED KIDS CARE, P.A.
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:
ARGELIA DOUGLAS, M.D. P.A.
Provider Other Organization Name Type Code:
4
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:
1376857706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5007 S MCCOLL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78539-8080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-587-0555
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5007 S MCCOLL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539-8080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-587-0555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DOUGLAS
Authorized Official First Name:
ARGELIA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
956-585-0365

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  J8999 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: PA08245 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA06319 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: AP113249 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 213904001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 213904002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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