Provider Demographics
NPI:1992952246
Name:LAURIE MCKILLIP M.D., P.A.
Entity type:Organization
Organization Name:LAURIE MCKILLIP M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKILLIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-296-8500
Mailing Address - Street 1:1120 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3242
Mailing Address - Country:US
Mailing Address - Phone:281-296-8500
Mailing Address - Fax:281-296-8594
Practice Address - Street 1:1120 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3242
Practice Address - Country:US
Practice Address - Phone:281-296-8500
Practice Address - Fax:281-296-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG9021OtherTEXAS LICENSE
TX8A0972OtherBLUE CROSS & BLUE SHEILD
TX586248OtherUNITED HEALTHCARE
TX03741OtherCIGNA
TX976050OtherAETNA
TXE79307OtherUPIN