Basic Information
Provider Information | |||||||||
NPI: | 1043582661 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SILVERBELL PEDIATRICS PA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1311 GENERAL CAVAZOS BLVD | ||||||||
Address2: | SUITE A | ||||||||
City: | KINGSVILLE | ||||||||
State: | TX | ||||||||
PostalCode: | 783637129 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3615954441 | ||||||||
FaxNumber: | 3615954448 | ||||||||
Practice Location | |||||||||
Address1: | 1311 GENERAL CAVAZOS BLVD | ||||||||
Address2: | SUITE A | ||||||||
City: | KINGSVILLE | ||||||||
State: | TX | ||||||||
PostalCode: | 783637129 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3615954441 | ||||||||
FaxNumber: | 3615954448 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/27/2012 | ||||||||
LastUpdateDate: | 01/27/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CHO | ||||||||
AuthorizedOfficialFirstName: | UNAM | ||||||||
AuthorizedOfficialMiddleName: | E | ||||||||
AuthorizedOfficialTitleorPosition: | PROVIDER/CHAIRMAN OF THE BOARD | ||||||||
AuthorizedOfficialTelephone: | 6315954441 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | SILVERBELL PEDIATRICS PA | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | L9139 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 167258601 | 05 | TX |   | MEDICAID |