Provider Demographics
NPI:1164445516
Name:PEDIDOCS PLLC
Entity Type:Organization
Organization Name:PEDIDOCS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLEHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-733-4362
Mailing Address - Street 1:9838 WESTOVER HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251
Mailing Address - Country:US
Mailing Address - Phone:210-733-4362
Mailing Address - Fax:210-521-1517
Practice Address - Street 1:9838 WESTOVER HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251
Practice Address - Country:US
Practice Address - Phone:210-733-4362
Practice Address - Fax:210-521-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182628101Medicaid