Provider Demographics
NPI:1033564232
Name:CLINT PEDIATRIC NIGHT CLINIC
Entity Type:Organization
Organization Name:CLINT PEDIATRIC NIGHT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHUKWUJEKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:OKPALAJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-209-3722
Mailing Address - Street 1:100 SAN ELIZARIO RD STE H
Mailing Address - Street 2:
Mailing Address - City:CLINT
Mailing Address - State:TX
Mailing Address - Zip Code:79836-6739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 SAN ELIZARIO RD STE H
Practice Address - Street 2:
Practice Address - City:CLINT
Practice Address - State:TX
Practice Address - Zip Code:79836-6739
Practice Address - Country:US
Practice Address - Phone:915-209-3722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2172208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty