Provider Demographics
NPI:1144476276
Name:VALLEY PEDIATRIC ASSOCIATES
Entity type:Organization
Organization Name:VALLEY PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PLOTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-541-5383
Mailing Address - Street 1:864 CENTRAL BLVD
Mailing Address - Street 2:STE 2400
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7551
Mailing Address - Country:US
Mailing Address - Phone:956-541-5383
Mailing Address - Fax:956-541-0302
Practice Address - Street 1:864 CENTRAL BLVD
Practice Address - Street 2:STE 2400
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7551
Practice Address - Country:US
Practice Address - Phone:956-541-5383
Practice Address - Fax:956-541-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG28122080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137119709OtherTMHP-CIDC
TXE02238OtherUPIN
TX00TU95OtherBLUE CROSS BLUE SHIELD
129764100OtherVALLEY BAPTIST HEALTH PLANS
TX137119707Medicaid