1295932325 NPI number — 18 AND UNDER MD, PA

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 1295932325 NPI number — 18 AND UNDER MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
18 AND UNDER MD, 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:
6
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:
1295932325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3041 CHURCHILL DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75022-5906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-691-1240
Provider Business Mailing Address Fax Number:
972-691-2073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3041 CHURCHILL DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
FLOWER MOUND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75022-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-691-1240
Provider Business Practice Location Address Fax Number:
972-691-2073
Provider Enumeration Date:
07/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
972-691-1240

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  L8145 , 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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