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NPI Code Detail

MEDICARE: AMARILLO PEDIATRIC ASSOCIATES, PLLC

MEDICARE: AMARILLO PEDIATRIC ASSOCIATES, PLLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1109449OTHERTXSUPERIOR HEALTH PLAN
20014CKOTHERTXBLUE CROSS

General Provider Information

NPI Number : 1184682221
Entity Type Code : Organization
Provider Name (Legal Business Name) : AMARILLO PEDIATRIC ASSOCIATES, PLLC
Provider Business Mailing Address
First Line : 1801 HALSTEAD ST
Second Line :
City : AMARILLO
State : TX
Zip : 79106-1811
Country : US
Telephone Number : 806-358-8526
Fax Number : 806-358-0179
Provider Business Practice Location Address
First Line : 1801 HALSTEAD ST
Second Line :
City : AMARILLO
State : TX
Zip : 79106-1830
Country : US
Telephone Number : 806-358-8526
Fax Number : 806-358-0179
Authorized Official
Title or Position : MANAGER
Name : SHU SHUM
Credential : MD
Telephone Number : 806-358-8526
Provider Enumeration Date : 05/01/2006
Last Update Date : 11/30/2007

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