Provider Demographics
NPI:1073898920
Name:CHILDRENS HEALTH CENTER, P.A.
Entity Type:Organization
Organization Name:CHILDRENS HEALTH CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-693-3988
Mailing Address - Street 1:1009 FALLS PKWY
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-4630
Mailing Address - Country:US
Mailing Address - Phone:830-693-3988
Mailing Address - Fax:830-693-5691
Practice Address - Street 1:1009 FALLS PKWY
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4630
Practice Address - Country:US
Practice Address - Phone:830-693-3988
Practice Address - Fax:830-693-5691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2834208000000X
261QP2300X, 261QP2300X
TXAP125831363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285147901Medicaid
TX285147902Medicaid
TX285147903Medicaid
TX2851479Medicaid
TX285147905Medicaid
TX285147904Medicaid