Provider Demographics
NPI:1417125154
Name:TEXAS PEDIATRIC PULMONARY CONSULTANTS, P.A.
Entity Type:Organization
Organization Name:TEXAS PEDIATRIC PULMONARY CONSULTANTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUSTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-416-3500
Mailing Address - Street 1:2251 W ELDORADO PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4358
Mailing Address - Country:US
Mailing Address - Phone:972-562-1188
Mailing Address - Fax:
Practice Address - Street 1:140 W LAMBERTH RD
Practice Address - Street 2:SUITE C
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2667
Practice Address - Country:US
Practice Address - Phone:903-416-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG26421Medicare UPIN