Organization
GERONIMO VILLAGE PEDIATRICS, PLLC
Active
Other names
Geronimo Village Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
JODI GAYLE KOENIG CPNP-AC/PC (OWNER)
(830) 372-8981
Entity
Organization
Contact information
Practice address
121 DENNIS DR, SEGUIN, TX 78155-0402
(830) 372-8981
(830) 372-8984
Mailing address
121 DENNIS DR, SEGUIN, TX 78155-0402
(830) 372-8981
(830) 372-8984
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339554303
—
TX
Enumeration date
03/15/2019
Last updated
06/11/2019
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