Provider Demographics
NPI:1881811149
Name:SUPERIOR PEDIATRICS
Entity type:Organization
Organization Name:SUPERIOR PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REMIGIO
Authorized Official - Middle Name:GUNGON
Authorized Official - Last Name:CAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-416-5372
Mailing Address - Street 1:1611 REGAL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3443
Mailing Address - Country:US
Mailing Address - Phone:817-416-5372
Mailing Address - Fax:
Practice Address - Street 1:3105 IRA E WOODS AVE
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3891
Practice Address - Country:US
Practice Address - Phone:817-416-5372
Practice Address - Fax:817-416-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5220261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care