Provider Demographics
NPI:1144613696
Name:ALLIED PEDIATRICIANS OF TEXAS, PLLC
Entity Type:Organization
Organization Name:ALLIED PEDIATRICIANS OF TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-696-4440
Mailing Address - Street 1:1602 ROCK PRAIRIE RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8307
Mailing Address - Country:US
Mailing Address - Phone:979-696-4440
Mailing Address - Fax:
Practice Address - Street 1:1602 ROCK PRAIRIE RD STE 1100
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8307
Practice Address - Country:US
Practice Address - Phone:979-696-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty