Provider Demographics
NPI:1265475891
Name:TEJAS PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:TEJAS PEDIATRICS, P.A.
Other - Org Name:TEJAS PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIROGA
Authorized Official - Suffix:
Authorized Official - Credentials:CMM, CMPM, EFPM
Authorized Official - Phone:210-479-3000
Mailing Address - Street 1:20642 STONE OAK PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7362
Mailing Address - Country:US
Mailing Address - Phone:210-479-3000
Mailing Address - Fax:210-479-3016
Practice Address - Street 1:20642 STONE OAK PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7362
Practice Address - Country:US
Practice Address - Phone:210-479-3000
Practice Address - Fax:210-479-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045296302Medicaid
TX1790876225OtherDR. TREXLER NPI
TX0015EZOtherBC CLINIC NUMBER
TX1629011242OtherBEATTY NPI
TX1780627919OtherBAUER NPI
TX1528009776OtherSTORANDT NPI
TX173321401Medicaid
TX173321402Medicaid
TX218136401OtherMEDICAID DR. HENIGAN
TX169952201OtherMEDICAID DR. STORANDT
TX111761604Medicaid
TX1194907183OtherDR. HENIGAN NPI
TXH28025Medicare UPIN