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General NPI Number Information
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NPI Number | 1700045200
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Entity Type | Organization
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Legal Business Name | PEDIATRIC OFFICES AT WILLOW BEND
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 6529 W PLANO PKWY SUITE B
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City | PLANO
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State | TX
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Zip | 75093-8209
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Country | US
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Telephone | 972-781-1414
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Fax | 972-781-1717
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Provider Business Mailing Address
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Address Line | 6529 W PLANO PKWY SUITE B
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City | PLANO
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State | TX
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Zip | 75093-8209
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Country | US
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Telephone | 972-781-1414
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Fax | 972-781-1717
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Authorized Official
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Title or Position | BILLING
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Name | KARI STARR
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Credential |
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Telephone | 972-781-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G8509
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License Number State | TX
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