1285165332 NPI number — PEDICARE CHILDRENS URGENT CARE PA

Table of content: (NPI 1285165332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285165332 NPI number — PEDICARE CHILDRENS URGENT CARE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDICARE CHILDRENS URGENT CARE PA
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:
1285165332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60893
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78466-0893
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-334-0613
Provider Business Mailing Address Fax Number:
361-214-2983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6326 YORKTOWN BLVD STE 1B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78414-5861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-334-0613
Provider Business Practice Location Address Fax Number:
361-334-0374
Provider Enumeration Date:
03/21/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ODUMUSI
Authorized Official First Name:
KOLAWOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
432-695-6300

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  P4362 , 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: Q5518 , 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)