Organization Name: | GRAND PRAIRIE PEDIATRICS |
NPI Number: | 1043551591 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRIAN MADDY (CEO) |
Mailing Address: | 7301 N Comanche Ave Warr Acres |
State: | OK US |
Postal Code: | 731326646 |
Phone Number: | 4057218090 |
Fax Number: | 4057228529 |
NPI Enumeration Date: | 03/08/2013 |
NPI Last Update Date: | 03/08/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |