Provider Demographics
NPI:1033598123
Name:PARK VALLEY PEDIATRICS, P.L.L.C.
Entity Type:Organization
Organization Name:PARK VALLEY PEDIATRICS, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HATHAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-255-7337
Mailing Address - Street 1:PO BOX 1255
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78680-1255
Mailing Address - Country:US
Mailing Address - Phone:512-255-7337
Mailing Address - Fax:512-828-0451
Practice Address - Street 1:16040 PARK VALLEY DR
Practice Address - Street 2:SUITE # 227
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3578
Practice Address - Country:US
Practice Address - Phone:512-255-7337
Practice Address - Fax:512-828-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty