Provider Demographics
NPI:1639509847
Name:PEDIPLACE
Entity Type:Organization
Organization Name:PEDIPLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-322-3663
Mailing Address - Street 1:7989 BELT LINE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-5734
Mailing Address - Country:US
Mailing Address - Phone:469-322-3662
Mailing Address - Fax:
Practice Address - Street 1:7989 BELT LINE RD
Practice Address - Street 2:#120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-5734
Practice Address - Country:US
Practice Address - Phone:469-322-3662
Practice Address - Fax:972-353-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty