Provider Demographics
NPI:1871833251
Name:HERRIN PEDIATRIC CLINIC-PA
Entity Type:Organization
Organization Name:HERRIN PEDIATRIC CLINIC-PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-788-6060
Mailing Address - Street 1:601 RIVER POINTE DR.
Mailing Address - Street 2:STE 120
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 RIVER POINTE DR.
Practice Address - Street 2:STE 120
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2943
Practice Address - Country:US
Practice Address - Phone:936-788-6060
Practice Address - Fax:936-788-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty