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General NPI Number Information
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NPI Number | 1114105574
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES OF GEORGETOWN, PA
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 103 THOUSAND OAKS BLVD
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City | GEORGETOWN
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State | TX
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Zip | 78628-8757
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Country | US
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Telephone | 512-930-7337
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Fax | 512-868-9817
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Provider Business Mailing Address
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Address Line | 103 THOUSAND OAKS BLVD
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City | GEORGETOWN
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State | TX
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Zip | 78628-8757
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Country | US
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Telephone | 512-930-7337
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Fax | 512-868-9817
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CRYSTAL MCBRIDE
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Credential |
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Telephone | 512-930-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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