Provider Demographics
NPI:1184682221
Name:AMARILLO PEDIATRIC ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:AMARILLO PEDIATRIC ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-358-8526
Mailing Address - Street 1:1801 HALSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1811
Mailing Address - Country:US
Mailing Address - Phone:806-358-8526
Mailing Address - Fax:806-358-0179
Practice Address - Street 1:1801 HALSTEAD ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1830
Practice Address - Country:US
Practice Address - Phone:806-358-8526
Practice Address - Fax:806-358-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109449OtherSUPERIOR HEALTH PLAN
TX0014CKOtherBLUE CROSS
TX109449OtherSUPERIOR HEALTH PLAN