Provider Demographics
NPI:1134548704
Name:CASTLE HILLS PEDIATRICS
Entity type:Organization
Organization Name:CASTLE HILLS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-492-2222
Mailing Address - Street 1:1821 GOLDEN TRAIL CT STE 200
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4675
Mailing Address - Country:US
Mailing Address - Phone:972-492-2222
Mailing Address - Fax:972-492-4453
Practice Address - Street 1:1821 GOLDEN TRAIL CT STE 200
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4675
Practice Address - Country:US
Practice Address - Phone:972-492-2222
Practice Address - Fax:972-492-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6687174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty