Provider Demographics
NPI:1760879670
Name:CAREVILLE PEDIATRICS, PA
Entity Type:Organization
Organization Name:CAREVILLE PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IFEANYI
Authorized Official - Middle Name:
Authorized Official - Last Name:MBADUGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-492-5252
Mailing Address - Street 1:1003 N SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-3420
Mailing Address - Country:US
Mailing Address - Phone:361-492-5252
Mailing Address - Fax:
Practice Address - Street 1:1003 N SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-3420
Practice Address - Country:US
Practice Address - Phone:361-492-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2492208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty