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General NPI Number Information
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NPI Number | 1205133287
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Entity Type | Organization
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Legal Business Name | PLANO CHILDREN'S MEDICAL CLINIC
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 303 S HIGHWAY 78 SUITE 106
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City | WYLIE
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State | TX
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Zip | 75098-3944
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Country | US
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Telephone | 972-801-9689
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Fax | 972-801-9015
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Provider Business Mailing Address
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Address Line | PO BOX 940109
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City | PLANO
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State | TX
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Zip | 75094-0109
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Country | US
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Telephone | 972-801-9689
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Fax | 972-801-9015
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SUSAN SHULER
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Credential |
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Telephone | 972-801-9689
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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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