Provider Demographics
NPI:1245589233
Name:HERITAGE PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:HERITAGE PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:210-826-8419
Mailing Address - Street 1:7959 BROADWAY ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2667
Mailing Address - Country:US
Mailing Address - Phone:210-824-7938
Mailing Address - Fax:210-805-9523
Practice Address - Street 1:7959 BROADWAY ST
Practice Address - Street 2:SUITE 604
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2667
Practice Address - Country:US
Practice Address - Phone:210-824-7938
Practice Address - Fax:210-805-9523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty