Provider Demographics
NPI:1376108944
Name:TOTS 2 TEENS KID CARE, PLLC
Entity Type:Organization
Organization Name:TOTS 2 TEENS KID CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:972-740-5572
Mailing Address - Street 1:2120 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-7132
Mailing Address - Country:US
Mailing Address - Phone:972-740-5572
Mailing Address - Fax:972-570-5672
Practice Address - Street 1:3626 N MACARTHUR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3643
Practice Address - Country:US
Practice Address - Phone:972-256-2028
Practice Address - Fax:972-570-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1316447360Medicaid
TX1235490046Medicaid
TX1497225478Medicaid
TX1932395746Medicaid