Provider Demographics
NPI:1437435856
Name:WEST TEXAS KID'S CLINIC, PLLC
Entity Type:Organization
Organization Name:WEST TEXAS KID'S CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRISHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCEACHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-939-2868
Mailing Address - Street 1:5004 FRANKFORD AVE UNIT 400
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1138
Mailing Address - Country:US
Mailing Address - Phone:806-771-5437
Mailing Address - Fax:
Practice Address - Street 1:5004 FRANKFORD AVE UNIT 400
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1138
Practice Address - Country:US
Practice Address - Phone:806-771-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty