Provider Demographics
NPI:1043582661
Name:SILVERBELL PEDIATRICS PA
Entity Type:Organization
Organization Name:SILVERBELL PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:UNAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-595-4441
Mailing Address - Street 1:1311 GENERAL CAVAZOS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-7129
Mailing Address - Country:US
Mailing Address - Phone:361-595-4441
Mailing Address - Fax:361-595-4448
Practice Address - Street 1:1311 GENERAL CAVAZOS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7129
Practice Address - Country:US
Practice Address - Phone:361-595-4441
Practice Address - Fax:361-595-4448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SILVERBELL PEDIATRICS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9139208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167258601Medicaid