Provider Demographics
NPI:1710021399
Name:PEDIATRIC HEALTH CONCEPTS, LTD
Entity Type:Organization
Organization Name:PEDIATRIC HEALTH CONCEPTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDAZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-668-7334
Mailing Address - Street 1:2403 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3475
Mailing Address - Country:US
Mailing Address - Phone:956-668-7334
Mailing Address - Fax:956-668-7331
Practice Address - Street 1:2403 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3475
Practice Address - Country:US
Practice Address - Phone:956-668-7334
Practice Address - Fax:956-668-7331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009921251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
679525Medicare ID - Type Unspecified