Provider Demographics
NPI:1144424995
Name:HEALTHY KIDS PEDIATRICS
Entity Type:Organization
Organization Name:HEALTHY KIDS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-294-0808
Mailing Address - Street 1:4851 LEGACY DR
Mailing Address - Street 2:SUITE 601
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0816
Mailing Address - Country:US
Mailing Address - Phone:972-294-0808
Mailing Address - Fax:972-294-0809
Practice Address - Street 1:4851 LEGACY DR
Practice Address - Street 2:SUITE 601
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-0816
Practice Address - Country:US
Practice Address - Phone:972-294-0808
Practice Address - Fax:972-294-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1083700314OtherDR. BAIN'S INDIVIDUAL NPI