Provider Demographics
NPI:1720189491
Name:GREATER NORTH TEXAS PEDIATRICS
Entity Type:Organization
Organization Name:GREATER NORTH TEXAS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ACCORDINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-553-0705
Mailing Address - Street 1:12200 PARK CENTRAL DRIVE #255
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251
Mailing Address - Country:US
Mailing Address - Phone:214-553-0705
Mailing Address - Fax:214-553-0706
Practice Address - Street 1:12200 PARK CENTRAL DRIVE #255
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251
Practice Address - Country:US
Practice Address - Phone:214-553-0705
Practice Address - Fax:214-553-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9023208000000X
TXG7374208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F67198Medicare UPIN
F10627Medicare UPIN