Provider Demographics
NPI:1689953093
Name:CHILD NEUROLOGY CLINICS OF TEXAS
Entity Type:Organization
Organization Name:CHILD NEUROLOGY CLINICS OF TEXAS
Other - Org Name:DALLAS PEDIATRIC NEUROLOGY ASSOCIATES, TEXAS CHILD NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-769-9000
Mailing Address - Street 1:4032 MCDERMOTT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024
Mailing Address - Country:US
Mailing Address - Phone:972-769-9000
Mailing Address - Fax:972-769-0035
Practice Address - Street 1:4032 MCDERMOTT DR STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:972-769-9000
Practice Address - Fax:972-769-0035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILD NEUROLOGY CLINICS OF TEXAS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-16
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty