Provider Demographics
NPI:1326083452
Name:WISE PEDIATRICS PA
Entity Type:Organization
Organization Name:WISE PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-627-4400
Mailing Address - Street 1:609 MEDICAL CENTER DRIVE
Mailing Address - Street 2:STE 2300
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234
Mailing Address - Country:US
Mailing Address - Phone:940-627-4400
Mailing Address - Fax:940-626-4411
Practice Address - Street 1:609 MEDICAL CENTER DRIVE
Practice Address - Street 2:STE 2300
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234
Practice Address - Country:US
Practice Address - Phone:940-627-4400
Practice Address - Fax:940-626-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty