Provider Demographics
NPI:1144615592
Name:GOOD SHEPHERD PEDIATRICS LLC
Entity Type:Organization
Organization Name:GOOD SHEPHERD PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:AYUKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-266-9688
Mailing Address - Street 1:1904 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-4339
Mailing Address - Country:US
Mailing Address - Phone:817-266-9688
Mailing Address - Fax:
Practice Address - Street 1:1904 BROOKVIEW DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-4339
Practice Address - Country:US
Practice Address - Phone:817-266-9688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health