Provider Demographics
NPI:1881819712
Name:TSION HAILESELASSIE, MD, PA, D.B.A GAINESVILLE PEDIATRICS
Entity Type:Organization
Organization Name:TSION HAILESELASSIE, MD, PA, D.B.A GAINESVILLE PEDIATRICS
Other - Org Name:GAINESVILLE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TSION
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HAILESELASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-665-9915
Mailing Address - Street 1:426 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-4324
Mailing Address - Country:US
Mailing Address - Phone:940-665-9915
Mailing Address - Fax:940-665-9962
Practice Address - Street 1:426 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4324
Practice Address - Country:US
Practice Address - Phone:940-665-9915
Practice Address - Fax:940-665-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5755208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156051802Medicaid
TXH78449Medicare UPIN
TX8A3678Medicare ID - Type Unspecified