1932555133 NPI number — DALLAS PEDIATRICS AND CHILDREN'S HEALTHCARE, 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 1932555133 NPI number — DALLAS PEDIATRICS AND CHILDREN'S HEALTHCARE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALLAS PEDIATRICS AND CHILDREN'S HEALTHCARE, 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:
1932555133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3409 SPECTRUM BLVD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75082-9713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-728-8867
Provider Business Mailing Address Fax Number:
972-231-0360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12606 GREENVILLE AVE STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-1926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-292-0072
Provider Business Practice Location Address Fax Number:
972-231-0360
Provider Enumeration Date:
05/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
AHMED
Authorized Official First Name:
ANISA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
214-728-8867

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , 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: 359470704 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 046074305 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 046074304 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 046074306 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 359470702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com