Provider Demographics
NPI:1568657658
Name:CHILDGROVE PEDIATRICS
Entity Type:Organization
Organization Name:CHILDGROVE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-304-0091
Mailing Address - Street 1:150 S DENTON TAP RD STE 116
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3323
Mailing Address - Country:US
Mailing Address - Phone:972-304-0091
Mailing Address - Fax:972-393-0959
Practice Address - Street 1:150 S DENTON TAP RD STE 116
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3323
Practice Address - Country:US
Practice Address - Phone:972-304-0091
Practice Address - Fax:972-393-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2379173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty