Provider Demographics
NPI:1265470603
Name:KILLEEN PEDIATRIC CARE CLINIC, P.A.
Entity Type:Organization
Organization Name:KILLEEN PEDIATRIC CARE CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-526-8300
Mailing Address - Street 1:2301 S CLEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4119
Mailing Address - Country:US
Mailing Address - Phone:254-526-8300
Mailing Address - Fax:254-526-4828
Practice Address - Street 1:2301 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4143
Practice Address - Country:US
Practice Address - Phone:254-526-8300
Practice Address - Fax:254-526-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty