Provider Demographics
NPI:1548235005
Name:MCKINNEY PEDIATRICS, PA
Entity Type:Organization
Organization Name:MCKINNEY PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:VERNIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-548-0758
Mailing Address - Street 1:1872 N. LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071
Mailing Address - Country:US
Mailing Address - Phone:972-548-0758
Mailing Address - Fax:972-548-0425
Practice Address - Street 1:1872 N. LAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071
Practice Address - Country:US
Practice Address - Phone:972-548-0758
Practice Address - Fax:972-548-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120182406Medicaid
TX092232003Medicaid
TX154695402Medicaid
TX154695402Medicaid
TX82Z551Medicare ID - Type Unspecified
TX120182406Medicaid
TX092232003Medicaid