Provider Demographics
NPI:1922353473
Name:PARK CITIES PEDIATRICS
Entity Type:Organization
Organization Name:PARK CITIES PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE, BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:RMA
Authorized Official - Phone:214-361-7185
Mailing Address - Street 1:8215 WESTCHESTER DR STE 111
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6109
Mailing Address - Country:US
Mailing Address - Phone:214-361-7185
Mailing Address - Fax:214-373-4841
Practice Address - Street 1:8215 WESTCHESTER DR STE 111
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6109
Practice Address - Country:US
Practice Address - Phone:214-361-7185
Practice Address - Fax:214-373-4841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2166208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty