Provider Demographics
NPI:1417095415
Name:PEDIATRIC PULMONARY ASSOC. OF N. TEXAS
Entity Type:Organization
Organization Name:PEDIATRIC PULMONARY ASSOC. OF N. TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-668-5864
Mailing Address - Street 1:8501 WADE BLVD
Mailing Address - Street 2:BLDG X, SUITE 1020
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5894
Mailing Address - Country:US
Mailing Address - Phone:972-668-5864
Mailing Address - Fax:972-668-5825
Practice Address - Street 1:8501 WADE BLVD
Practice Address - Street 2:BLDG X, SUITE 1020
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5894
Practice Address - Country:US
Practice Address - Phone:972-566-5864
Practice Address - Fax:972-566-5825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081278601Medicaid