1700020682 NPI number — FIRST STEPS PEDIATRICS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700020682 NPI number — FIRST STEPS PEDIATRICS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST STEPS PEDIATRICS, 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:
1700020682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9910 W. LOOP 1604 N.
Provider Second Line Business Mailing Address:
SUITE 124
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-692-0358
Provider Business Mailing Address Fax Number:
210-692-0359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9910 W. LOOP 1604 N.
Provider Second Line Business Practice Location Address:
SUITE 124
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-692-0358
Provider Business Practice Location Address Fax Number:
210-692-0359
Provider Enumeration Date:
04/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LANTRY
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
210-692-0358

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  K2944 , 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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