Organization
MEDINA VALLEY PEDIATRICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATIE SUE RUSSELL RN, MSN, CPNP (PRESIDENT)
(830) 355-2732
Entity
Organization
Contact information
Practice address
1028 COUNTRY LN, CASTROVILLE, TX 78009-5027
(210) 232-6464
Mailing address
1028 COUNTRY LANE, CASTROVILLE, TX 78009
(830) 355-2732
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
AP115944
TX
Other
Enumeration date
02/21/2017
Last updated
08/07/2017
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