Provider Demographics
NPI:1316957731
Name:PROFESSIONAL ASSN FOR PEDIATRICS
Entity type:Organization
Organization Name:PROFESSIONAL ASSN FOR PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:TUEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-677-2801
Mailing Address - Street 1:1850 HICKORY ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2334
Mailing Address - Country:US
Mailing Address - Phone:325-677-2801
Mailing Address - Fax:
Practice Address - Street 1:1850 HICKORY ST
Practice Address - Street 2:SUITE #102
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2334
Practice Address - Country:US
Practice Address - Phone:325-677-2801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R10ZOtherBCBS
TX111638604Medicaid
TX111638603OtherMEDICAID THSTEPS
TX111638604Medicaid