Basic Information
| Provider Information | |||||||||
| NPI: | 1528183019 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITAL PEDIATRIC GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 W 39 ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787563902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124544545 | ||||||||
| FaxNumber: | 5122790445 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 W 39 ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787563902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124544545 | ||||||||
| FaxNumber: | 5122790445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CAMPBELL | ||||||||
| AuthorizedOfficialFirstName: | DOROTHY | ||||||||
| AuthorizedOfficialMiddleName: | CAROLE | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5124544545 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.