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General NPI Number Information
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NPI Number | 1346264538
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Entity Type | Organization
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Legal Business Name | UNIV PHYS AMARILLO PEDI PARTNERS
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 1400 WALLACE BLVD
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City | AMARILLO
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State | TX
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Zip | 79106-1708
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Country | US
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Telephone | 806-354-5630
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Fax | 806-354-5689
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Provider Business Mailing Address
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Address Line | 1400 S COULTER ST
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City | AMARILLO
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State | TX
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Zip | 79106-1786
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Country | US
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Telephone | 806-354-5630
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Fax | 806-354-5689
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | DENISE RUSSELL
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Credential | CPCS
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Telephone | 806-354-5495
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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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