Organization Name: | PEDIATRIC PRACTICE ASSOCIATION |
NPI Number: | 1265518914 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANA FALCON (CREDENTIALING CLERK) |
Mailing Address: | 201 E 2nd St Rio Grande City |
State: | TX US |
Postal Code: | 785823803 |
Phone Number: | 9564881200 |
Fax Number: | 9564889500 |
NPI Enumeration Date: | 10/27/2006 |
NPI Last Update Date: | 01/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | L4155 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |