Provider Demographics
NPI:1659363497
Name:THE PEDIATRIC CENTER OF SOUTH TEXAS
Entity Type:Organization
Organization Name:THE PEDIATRIC CENTER OF SOUTH TEXAS
Other - Org Name:THE PEDIATRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-992-9200
Mailing Address - Street 1:5323 S MCCOLL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9115
Mailing Address - Country:US
Mailing Address - Phone:956-992-9200
Mailing Address - Fax:956-992-9209
Practice Address - Street 1:5323 S MCCOLL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9115
Practice Address - Country:US
Practice Address - Phone:956-992-9200
Practice Address - Fax:956-992-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2426174400000X
TXJ8999174400000X
TXK3878174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherPRIVATE INSURANCE
TXGI4455Medicare UPIN
TX=========OtherPRIVATE INSURANCE
TXE09444Medicare UPIN