=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023872793
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES PEDIATRICS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2024
-----------------------------------------------------
Last Update Date | 02/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 EAST AVE
-----------------------------------------------------
City | SCHULENBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78956-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-743-3520
-----------------------------------------------------
Fax | 979-743-3542
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 359
-----------------------------------------------------
City | SCHULENBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78956-0359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-743-3520
-----------------------------------------------------
Fax | 877-829-1531
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING SUPERVISOR
-----------------------------------------------------
Name | PAMELA WYANT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 979-249-6590
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------