Provider Demographics
NPI:1285955872
Name:DEMING PEDIATRICS PLLC
Entity type:Organization
Organization Name:DEMING PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEMING
Authorized Official - Suffix:
Authorized Official - Credentials:PNP
Authorized Official - Phone:361-553-6844
Mailing Address - Street 1:1300 N VIRGINIA ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-2509
Mailing Address - Country:US
Mailing Address - Phone:361-553-6844
Mailing Address - Fax:361-553-7314
Practice Address - Street 1:1300 N VIRGINIA ST
Practice Address - Street 2:SUITE 111
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2509
Practice Address - Country:US
Practice Address - Phone:361-553-6844
Practice Address - Fax:361-553-7314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX587712363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1969230-03Medicaid
TX1969230-02Medicaid