Provider Demographics
NPI:1992273692
Name:ACME PEDIATRIC PROVIDERS PLLC
Entity type:Organization
Organization Name:ACME PEDIATRIC PROVIDERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUJICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-968-0103
Mailing Address - Street 1:1408 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6639
Mailing Address - Country:US
Mailing Address - Phone:956-968-0103
Mailing Address - Fax:
Practice Address - Street 1:1206 S F ST STE 1
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6783
Practice Address - Country:US
Practice Address - Phone:956-444-0844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL1521OtherTEXAS MEDICAL BOARD