Provider Demographics
NPI:1649300278
Name:HELOTES PEDIATRICS, P.A.
Entity type:Organization
Organization Name:HELOTES PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-372-0505
Mailing Address - Street 1:12274 BANDERA RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4385
Mailing Address - Country:US
Mailing Address - Phone:210-372-0505
Mailing Address - Fax:210-372-0404
Practice Address - Street 1:12274 BANDERA RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4385
Practice Address - Country:US
Practice Address - Phone:210-372-0505
Practice Address - Fax:210-372-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0026KPOtherBCBS GRP #
TX159585201Medicaid
TX159585202Medicaid