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General NPI Number Information
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NPI Number | 1891848552
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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 | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1600 S COULTER ST SUITE F600
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City | AMARILLO
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State | TX
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Zip | 79106-1710
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Country | US
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Telephone | 806-468-4300
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Fax | 806-468-4398
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Provider Business Mailing Address
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Address Line | 1600 S COULTER ST SUITE F600
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City | AMARILLO
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State | TX
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Zip | 79106-1710
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Country | US
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Telephone | 806-468-4300
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Fax | 806-468-4398
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MRS. 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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | TX
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