Provider Demographics
NPI:1104220573
Name:CAVALIER JOY & CROWN PEDIATRIC SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:CAVALIER JOY & CROWN PEDIATRIC SPECIALISTS, PLLC
Other - Org Name:JOY & CROWN PEDIATRIC SPECIALISTS, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-213-7634
Mailing Address - Street 1:PO BOX 6023
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0226
Mailing Address - Country:US
Mailing Address - Phone:469-213-7634
Mailing Address - Fax:469-535-3664
Practice Address - Street 1:7002 LEBANON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7461
Practice Address - Country:US
Practice Address - Phone:469-213-7633
Practice Address - Fax:469-535-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9913261QI0500X, 261QM2500X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty