Provider Demographics
NPI:1073218780
Name:VITAL SIGNS PEDIATRICS PLLC
Entity Type:Organization
Organization Name:VITAL SIGNS PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSIESY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-453-7762
Mailing Address - Street 1:17774 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5736
Mailing Address - Country:US
Mailing Address - Phone:929-453-7764
Mailing Address - Fax:
Practice Address - Street 1:1011 W GRANDE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5772
Practice Address - Country:US
Practice Address - Phone:929-453-7764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care