Healthcare Provider Details

I. General information

NPI: 1821085721
Provider Name (Legal Business Name): THE PEDIATRIC CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N JEFFERSON AVE SUITE 300
MOUNT PLEASANT TX
75455-2371
US

IV. Provider business mailing address

2001 N JEFFERSON AVE STE 300
MOUNT PLEASANT TX
75455-2375
US

V. Phone/Fax

Practice location:
  • Phone: 903-572-9823
  • Fax: 903-572-4812
Mailing address:
  • Phone: 903-572-9823
  • Fax: 903-572-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HENRY
Title or Position: OWNER
Credential: MD
Phone: 903-572-9823