Provider Demographics
NPI:1003031063
Name:ALAMO HEIGHTS PEDIATRICS
Entity Type:Organization
Organization Name:ALAMO HEIGHTS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:IRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:210-930-8400
Mailing Address - Street 1:555 E BASSE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-8329
Mailing Address - Country:US
Mailing Address - Phone:210-930-8400
Mailing Address - Fax:210-930-8402
Practice Address - Street 1:555 E BASSE RD STE 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-8329
Practice Address - Country:US
Practice Address - Phone:210-930-8400
Practice Address - Fax:210-930-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9890208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0089JQMedicaid