Provider Demographics
NPI:1184809352
Name:SPRING CREEK PEDIATRIC CENTER
Entity type:Organization
Organization Name:SPRING CREEK PEDIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-572-9400
Mailing Address - Street 1:110 MEDICAL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3101
Mailing Address - Country:US
Mailing Address - Phone:361-572-9400
Mailing Address - Fax:361-572-4415
Practice Address - Street 1:110 MEDICAL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3101
Practice Address - Country:US
Practice Address - Phone:361-572-9400
Practice Address - Fax:361-572-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1447208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC20174Medicare UPIN