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General NPI Number Information
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NPI Number | 1528316551
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Entity Type | Organization
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Legal Business Name | BUMPS N' BRUISES PEDIATRIC URGENT CARE CENTER
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Dates
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Enumeration Date | 08/23/2012
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Last Update Date | 08/23/2012
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Provider Practice Location Address
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Address Line | 2251 MATLOCK RD
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City | MANSFIELD
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State | TX
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Zip | 76063-3825
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Country | US
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Telephone | 330-495-6359
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Fax |
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Provider Business Mailing Address
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Address Line | 2251 MATLOCK RD
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City | MANSFIELD
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State | TX
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Zip | 76063-3825
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Country | US
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Telephone | 330-495-6359
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT COORDINATOR
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Name | EMMA HOLTON
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Credential |
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Telephone | 804-643-2287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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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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