Provider Demographics
NPI:1962532531
Name:BATTA PEDIATRIC CLINIC, PA
Entity type:Organization
Organization Name:BATTA PEDIATRIC CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-399-7700
Mailing Address - Street 1:2569 HWY BUSINESS 77
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4172
Mailing Address - Country:US
Mailing Address - Phone:956-399-7700
Mailing Address - Fax:956-399-7702
Practice Address - Street 1:2569 HWY BUSINESS 77
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-4172
Practice Address - Country:US
Practice Address - Phone:956-399-7700
Practice Address - Fax:956-399-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3083208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130883507Medicaid
TX130883508Medicaid
TX182705701Medicaid
TX=========OtherTAX ID NO.