Provider Demographics
NPI:1952446593
Name:NORTHWEST PEDIATRIC ASSOCIATES
Entity type:Organization
Organization Name:NORTHWEST PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-680-6000
Mailing Address - Street 1:7007 BANDERA RD
Mailing Address - Street 2:SUITE 19
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1265
Mailing Address - Country:US
Mailing Address - Phone:210-680-6000
Mailing Address - Fax:210-680-9153
Practice Address - Street 1:7007 BANDERA RD
Practice Address - Street 2:SUITE 19
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1138
Practice Address - Country:US
Practice Address - Phone:210-680-6000
Practice Address - Fax:210-256-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00SN08OtherBLUE CROSS
TX1952446593OtherNPI
TX1952446593OtherNPI