Provider Demographics
NPI:1003912197
Name:CHILDREN'S MEDICAL CENTER
Entity Type:Organization
Organization Name:CHILDREN'S MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA FOR PEDIATRIC NEUROSURGERY
Authorized Official - Prefix:MR
Authorized Official - First Name:BOUAPHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HONGKEO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:214-456-6660
Mailing Address - Street 1:2300 MESA OAK TRL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4721
Mailing Address - Country:US
Mailing Address - Phone:214-280-9267
Mailing Address - Fax:
Practice Address - Street 1:1935 MOTOR ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-6660
Practice Address - Fax:214-456-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04770282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren