Provider Demographics
NPI:1780089045
Name:SGH PEDIATRICS, PLLC
Entity type:Organization
Organization Name:SGH PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON-HULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:682-223-1696
Mailing Address - Street 1:901 W WALL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7414
Mailing Address - Country:US
Mailing Address - Phone:682-223-1696
Mailing Address - Fax:817-488-6671
Practice Address - Street 1:800 W ARBROOK BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4327
Practice Address - Country:US
Practice Address - Phone:682-223-1696
Practice Address - Fax:817-488-6671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4392208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty