MEDICARE: TEXAS PEDIATRICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	208000000X	Pediatrics Physician
2	363A00000X	Physician Assistant
3	363LP2300X	Primary Care Nurse Practitioner
4	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1154142305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS PEDIATRICS PLLC

Provider Business Mailing Address
First Line	:	1701 RIVER RUN STE 302
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6547
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 RIVER RUN STE 302
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6547
Country	:	US
Telephone Number	:	281-203-5006
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	SHELBY WINSCHEL
Credential	:
Telephone Number	:	254-768-3397

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	10/21/2024

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