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General NPI Number Information
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NPI Number | 1003912197
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Entity Type | Organization
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Legal Business Name | CHILDREN'S MEDICAL CENTER
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 1935 MOTOR ST
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City | DALLAS
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State | TX
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Zip | 75235-7701
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Country | US
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Telephone | 214-456-6660
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Fax | 214-456-6696
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Provider Business Mailing Address
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Address Line | 2300 MESA OAK TRL
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City | PLANO
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State | TX
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Zip | 75025-4721
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Country | US
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Telephone | 214-280-9267
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Fax |
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Authorized Official
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Title or Position | PA FOR PEDIATRIC NEUROSURGERY
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Name | MR. BOUAPHANE HONGKEO
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Credential | PA
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Telephone | 214-456-6660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | PA04770
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License Number State | TX
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