1851635452 NPI number — PEDIATRIC PARTNERS OF AUSTIN, P.A.

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 1851635452 NPI number — PEDIATRIC PARTNERS OF AUSTIN, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC PARTNERS OF AUSTIN, 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:
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:
1851635452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 678053
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75267-8053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-241-0546
Provider Business Mailing Address Fax Number:
512-241-0937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3410 FAR WEST BLVD STE 130
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:
78731-3167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-345-6758
Provider Business Practice Location Address Fax Number:
512-345-1469
Provider Enumeration Date:
11/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TERWELP
Authorized Official First Name:
DAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
512-345-6758

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)





Copyright © 2007-2025 www.npivalidator.com