Provider Demographics
NPI:1649417577
Name:KIDLUNGS PEDIATRIC PULMONOLOGY, PA
Entity Type:Organization
Organization Name:KIDLUNGS PEDIATRIC PULMONOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:REMBECKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:214-618-5437
Mailing Address - Street 1:3550 PARKWOOD BLVD
Mailing Address - Street 2:BLDG G SUITE 701
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1903
Mailing Address - Country:US
Mailing Address - Phone:214-618-5437
Mailing Address - Fax:214-618-8226
Practice Address - Street 1:3550 PARKWOOD BLVD
Practice Address - Street 2:BLDG G SUITE 701
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1903
Practice Address - Country:US
Practice Address - Phone:214-618-5437
Practice Address - Fax:214-618-8226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2461174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0025KCOtherBLUE CROSS
TX1151805-04Medicaid
TXF42580OtherUPIN