Provider Demographics
NPI:1013017912
Name:JOLET PATIL AND RIMER PEDIATRICS PA
Entity Type:Organization
Organization Name:JOLET PATIL AND RIMER PEDIATRICS PA
Other - Org Name:SOUTHWEST PEDIATRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VAISHALEE
Authorized Official - Middle Name:SANJAY
Authorized Official - Last Name:PATIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-288-9669
Mailing Address - Street 1:7900 FM 1826
Mailing Address - Street 2:220
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-1407
Mailing Address - Country:US
Mailing Address - Phone:512-288-9669
Mailing Address - Fax:512-498-0317
Practice Address - Street 1:7900 FM 1826
Practice Address - Street 2:220
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-1407
Practice Address - Country:US
Practice Address - Phone:512-288-9669
Practice Address - Fax:512-498-0317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2538208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184619801Medicaid
TX184619802Medicaid