Provider Demographics
NPI:1891136990
Name:PRESTON WOOD PEDIATRICS, LLC
Entity Type:Organization
Organization Name:PRESTON WOOD PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WURNEICE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CUINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-349-1313
Mailing Address - Street 1:318 W BELT LINE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1104
Mailing Address - Country:US
Mailing Address - Phone:972-349-1313
Mailing Address - Fax:888-371-6987
Practice Address - Street 1:318 W BELT LINE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1104
Practice Address - Country:US
Practice Address - Phone:972-349-1313
Practice Address - Fax:888-371-6987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
TX015866251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8000935392Medicaid