1912123985 NPI number — MCKINNEY ABC PEDIATRICS, P.A.

Table of content: (NPI 1912123985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912123985 NPI number — MCKINNEY ABC PEDIATRICS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCKINNEY ABC PEDIATRICS, 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:
ABC PEDIATRICS
Provider Other Organization Name Type Code:
3
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:
1912123985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2146
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75070-8165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-569-9904
Provider Business Mailing Address Fax Number:
972-569-9943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5333 W. UNIVERSITY DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-569-9904
Provider Business Practice Location Address Fax Number:
972-569-9943
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DONDERO
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
972-569-9904

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  K2007 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: M1578 , 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: 198460102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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