Healthcare Provider Details

I. General information

NPI: 1073898920
Provider Name (Legal Business Name): CHILDRENS HEALTH CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 FALLS PKWY
MARBLE FALLS TX
78654-4630
US

IV. Provider business mailing address

1009 FALLS PKWY
MARBLE FALLS TX
78654-4630
US

V. Phone/Fax

Practice location:
  • Phone: 830-693-3988
  • Fax: 830-693-5691
Mailing address:
  • Phone: 830-693-3988
  • Fax: 830-693-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH2834
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP125831
License Number StateTX

VIII. Authorized Official

Name: SANDRA K THOMAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 830-693-3988