NPIMap

Organization Active NPI

Old Town Pediatrics of Mesquite PA

  • Pediatric Adolescent Medicine Physician
  • Mesquite, TX
National Provider Identifier
1164775391
Registry record updated Jan 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
OLD TOWN PEDIATRICS OF MESQUITE PA
Practice address
502 W Kearney St
#700
Mesquite, TX 75149-3401
Phone
(972) 288-7337
Fax
(972) 289-9076
NPI assigned
Oct 25, 2012
Last updated
Jan 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laura Stiles, D.O.
Title
Owner
Phone
(214) 454-9452

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X NU Primary

Addresses

Primary practice location

502 W Kearney St
#700
Mesquite, TX 75149-3401

Mailing address

502 W Kearney St
#700
Mesquite, TX 75149-3401
Phone (972) 288-7337

National Provider Directory

National Provider Directory
Tax ID family
Old Town Pediatrics of Mesquite PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359072000000",
    "number": "1164775391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 W KEARNEY ST",
            "address_2": "#700",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751493401",
            "telephone_number": "972-288-7337",
            "fax_number": "972-289-9076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 W KEARNEY ST",
            "address_2": "#700",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751493401",
            "telephone_number": "972-288-7337",
            "fax_number": "972-289-9076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD TOWN PEDIATRICS OF MESQUITE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2013-01-25",
        "status": "A",
        "authorized_official_last_name": "STILES",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-454-9452",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesquite, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.