Provider Demographics
NPI:1851576516
Name:ELGIN PEDIATRICS, PA
Entity Type:Organization
Organization Name:ELGIN PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-281-0994
Mailing Address - Street 1:214 HIGHWAY 290 E
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-3214
Mailing Address - Country:US
Mailing Address - Phone:512-281-0994
Mailing Address - Fax:512-285-4100
Practice Address - Street 1:214 HIGHWAY 290 E
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-3214
Practice Address - Country:US
Practice Address - Phone:512-281-0994
Practice Address - Fax:512-285-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK66122080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty