Provider Demographics
NPI:1154425494
Name:ANGELINA PEDIATRICS PLLC
Entity type:Organization
Organization Name:ANGELINA PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:FIDONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-634-9233
Mailing Address - Street 1:PO BOX 150638
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915
Mailing Address - Country:US
Mailing Address - Phone:936-634-9233
Mailing Address - Fax:936-634-9353
Practice Address - Street 1:1222 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3326
Practice Address - Country:US
Practice Address - Phone:936-634-9233
Practice Address - Fax:936-634-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092130602Medicaid