Provider Demographics
NPI:1831497817
Name:AMARILLO INFECTIOUS DISEASES CONSULTANTS, PA
Entity Type:Organization
Organization Name:AMARILLO INFECTIOUS DISEASES CONSULTANTS, PA
Other - Org Name:AMARILLO ID CONSULTANTS, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:S
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-356-2280
Mailing Address - Street 1:1215 S COULTER ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1758
Mailing Address - Country:US
Mailing Address - Phone:806-356-2280
Mailing Address - Fax:806-677-7617
Practice Address - Street 1:1215 S COULTER ST
Practice Address - Street 2:SUITE 401
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1758
Practice Address - Country:US
Practice Address - Phone:806-356-2280
Practice Address - Fax:806-677-7617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2463207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF94293Medicare UPIN