Provider Demographics
NPI:1164597324
Name:NICOLAS RICH JR MD FAAP PA
Entity Type:Organization
Organization Name:NICOLAS RICH JR MD FAAP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:915-544-4484
Mailing Address - Street 1:2905 N STANTON ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2510
Mailing Address - Country:US
Mailing Address - Phone:915-544-4484
Mailing Address - Fax:915-544-4590
Practice Address - Street 1:2905 N STANTON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2510
Practice Address - Country:US
Practice Address - Phone:915-544-4484
Practice Address - Fax:915-544-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157088901OtherMEDICAID GROUP