Provider Demographics
NPI:1013382092
Name:HEALTH AND HEALING PEDIATRIC CLINIC, PLLC
Entity Type:Organization
Organization Name:HEALTH AND HEALING PEDIATRIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:MOIN
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-640-4872
Mailing Address - Street 1:3900 W 15TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7789
Mailing Address - Country:US
Mailing Address - Phone:972-964-7773
Mailing Address - Fax:
Practice Address - Street 1:3900 W 15TH ST STE 107
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7789
Practice Address - Country:US
Practice Address - Phone:972-964-7773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213476913Medicaid