1417125154 NPI number — TEXAS PEDIATRIC PULMONARY CONSULTANTS, P.A.

Table of content: (NPI 1417125154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417125154 NPI number — TEXAS PEDIATRIC PULMONARY CONSULTANTS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS PEDIATRIC PULMONARY CONSULTANTS, 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:
1417125154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2251 W ELDORADO PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75070-4358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-562-1188
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 W LAMBERTH RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75092-2667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-416-3500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BUSTILLO
Authorized Official First Name:
MAYRA
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
903-416-3500

Provider Taxonomy Codes

  • Taxonomy code: 2080P0214X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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