Provider Demographics
NPI:1114323862
Name:PEDIATRIC CENTER OF GRAND PRAIRIE
Entity Type:Organization
Organization Name:PEDIATRIC CENTER OF GRAND PRAIRIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHLEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-401-0700
Mailing Address - Street 1:701 TUSCAN DR
Mailing Address - Street 2:SUITE 285
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4133
Mailing Address - Country:US
Mailing Address - Phone:972-401-0700
Mailing Address - Fax:
Practice Address - Street 1:4927 LAKE RIDGE PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3087
Practice Address - Country:US
Practice Address - Phone:972-401-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6133208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty