Provider Demographics
NPI:1932921293
Name:VILLAGE PEDIATRICS WACO PLLC
Entity type:Organization
Organization Name:VILLAGE PEDIATRICS WACO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:254-744-4777
Mailing Address - Street 1:1046 MORNING STAR CIR
Mailing Address - Street 2:
Mailing Address - City:CHINA SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:76633-3316
Mailing Address - Country:US
Mailing Address - Phone:254-744-4777
Mailing Address - Fax:
Practice Address - Street 1:4515 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-1814
Practice Address - Country:US
Practice Address - Phone:254-269-3099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty