Provider Demographics
NPI:1841371317
Name:PHYSICIANS FOR CHILDREN
Entity type:Organization
Organization Name:PHYSICIANS FOR CHILDREN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-456-6715
Mailing Address - Street 1:PO BOX 844582
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4582
Mailing Address - Country:US
Mailing Address - Phone:214-456-4550
Mailing Address - Fax:214-456-4490
Practice Address - Street 1:2350 N STEMMONS FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2700
Practice Address - Country:US
Practice Address - Phone:469-488-7100
Practice Address - Fax:469-488-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5767208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200943301Medicaid
TX200978901Medicaid
TX324083004Medicaid
TX092419301Medicaid
TX472611Other162.001(B) NONPROFIT ORG
TX215293601Medicaid
TX315041901Medicaid
TX200950801Medicaid
TX312059401Medicaid
TX312874601Medicaid
TX298410601Medicaid
TX312162601Medicaid
TX326667801Medicaid
TX216064001Medicaid
TX296409001Medicaid
TX311619601Medicaid
TX323239901Medicaid