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Organization
UNIV PHYS AMARILLO PEDI PARTNERS
Active
Organization
UNIV PHYS AMARILLO PEDI PARTNERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE RUSSELL CPCS (CREDENTIALING COORDINATOR)
(806) 354-5495
Entity
Organization
Contact information
Practice address
1400 WALLACE BLVD, AMARILLO, TX 79106-1708
(806) 354-5630
(806) 354-5689
Mailing address
1400 S COULTER ST, AMARILLO, TX 79106-1786
(806) 354-5630
(806) 354-5689
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163173101
—
TX
05
—
163173102
—
TX
05
—
163173103
—
TX
05
—
163173104
—
TX
05
—
163173105
—
TX
05
—
163173106
—
TX
05
—
200028530 A
—
OK
05
—
73623547
—
NM
Enumeration date
07/27/2006
Last updated
04/01/2014
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