Provider Demographics
NPI:1427375294
Name:PEDCARE, PA
Entity Type:Organization
Organization Name:PEDCARE, PA
Other - Org Name:KIDS WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-682-1791
Mailing Address - Street 1:3228 INTERSTATE 30
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2633
Mailing Address - Country:US
Mailing Address - Phone:972-682-1791
Mailing Address - Fax:972-698-7641
Practice Address - Street 1:3228 INTERSTATE 30
Practice Address - Street 2:SUITE 300
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2633
Practice Address - Country:US
Practice Address - Phone:972-682-1791
Practice Address - Fax:972-698-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty