Organization Name: | TROPHY CLUB PEDIATRICS PA |
NPI Number: | 1083034839 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHARLES O ONYEAMA (PEDIATRICIAN) |
Mailing Address: | 2811 Mona Vale Rd Trophy Club |
State: | TX US |
Postal Code: | 762623479 |
Phone Number: | 7085744199 |
Fax Number: | |
NPI Enumeration Date: | 04/21/2014 |
NPI Last Update Date: | 08/13/2014 |
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: |