Provider Demographics
NPI:1093136541
Name:SHERIF PEDIATRICS CLINIC
Entity Type:Organization
Organization Name:SHERIF PEDIATRICS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BC PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-537-5171
Mailing Address - Street 1:5419 N LOVINGTON HWY
Mailing Address - Street 2:BLDG # 1, SUITE # 2
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-9100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5419 N LOVINGTON HWY
Practice Address - Street 2:BLDG # 1, SUITE # 2
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9100
Practice Address - Country:US
Practice Address - Phone:575-392-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM208000000X261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM94887551Medicaid
NMNMAAA0272Medicare PIN