Provider Demographics
NPI:1891848552
Name:UNIV PHYS, AMARILLO PEDI-PARTNERS
Entity Type:Organization
Organization Name:UNIV PHYS, AMARILLO PEDI-PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:806-354-5495
Mailing Address - Street 1:1600 S COULTER ST
Mailing Address - Street 2:SUITE F600
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1710
Mailing Address - Country:US
Mailing Address - Phone:806-468-4300
Mailing Address - Fax:806-468-4398
Practice Address - Street 1:1600 S COULTER ST
Practice Address - Street 2:SUITE F600
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1710
Practice Address - Country:US
Practice Address - Phone:806-468-4300
Practice Address - Fax:806-468-4398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory