Provider Demographics
NPI:1356396980
Name:NUBY PEDIATRICS PA
Entity type:Organization
Organization Name:NUBY PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-566-5437
Mailing Address - Street 1:1208 BENT OAKS CT
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-3300
Mailing Address - Country:US
Mailing Address - Phone:940-566-5437
Mailing Address - Fax:940-323-0553
Practice Address - Street 1:1208 BENT OAKS CT
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-3300
Practice Address - Country:US
Practice Address - Phone:940-566-5437
Practice Address - Fax:940-323-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178528602OtherMEDICAID THS
TX10046727OtherAMERIGROUP
TX0011NJOtherBCBSTX
TX178582601Medicaid
TX0011NJOtherBCBSTX