Provider Demographics
NPI:1336333806
Name:INWOOD VILLAGE PEDIATRICS
Entity Type:Organization
Organization Name:INWOOD VILLAGE PEDIATRICS
Other - Org Name:WESTCHESTER PEDIATRICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-956-7337
Mailing Address - Street 1:5470 W. LOVERS LANE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209
Mailing Address - Country:US
Mailing Address - Phone:214-956-7337
Mailing Address - Fax:214-466-8289
Practice Address - Street 1:5470 W. LOVERS LANE
Practice Address - Street 2:SUITE 330
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209
Practice Address - Country:US
Practice Address - Phone:214-956-7337
Practice Address - Fax:214-466-8289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4488208000000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty