1659363497 NPI number — THE PEDIATRIC CENTER OF SOUTH TEXAS

Table of content: TRAVIS TAYLOR APRN, PMHNP (NPI 1053903245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659363497 NPI number — THE PEDIATRIC CENTER OF SOUTH TEXAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE PEDIATRIC CENTER OF SOUTH TEXAS
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:
1659363497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5323 S MCCOLL RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
EDINBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78539-9115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-992-9200
Provider Business Mailing Address Fax Number:
956-992-9209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5323 S MCCOLL RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539-9115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-992-9200
Provider Business Practice Location Address Fax Number:
956-992-9209
Provider Enumeration Date:
08/18/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARZA
Authorized Official First Name:
YVETTE
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
956-992-9200

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  J8999 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: K3878 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: H2426 , 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)