Provider Demographics
NPI:1114105574
Name:PEDIATRIC ASSOCIATES OF GEORGETOWN, PA
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF GEORGETOWN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-930-7337
Mailing Address - Street 1:103 THOUSAND OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-8757
Mailing Address - Country:US
Mailing Address - Phone:512-930-7337
Mailing Address - Fax:512-868-9817
Practice Address - Street 1:103 THOUSAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-8757
Practice Address - Country:US
Practice Address - Phone:512-930-7337
Practice Address - Fax:512-868-9817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty