Pediaq Texas LLC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

Legal business name

PEDIAQ TEXAS LLC

Practice address

17101 Preston Rd
Ste 115
Dallas, TX 75248-1331

Phone

(214) 984-3900

Fax

(972) 294-3343

NPI assigned

Sep 1, 2015

Organization subpart

Yes

Parent organization

PEDIAQ LLCAs reported in NPPES

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

Authorized official

Name

Jon Osullivan

Title

Owner

Phone

21498439000

Specialties & licenses 2

Addresses

Tax ID family

Pediaq LLC2 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.

• Pediaq LLC

  • Primary Care Clinic/Center
  • Austin, TX
  • NPI 1255885745
  NPD tax ID

Locations

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

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441065600000",
    "number": "1326415779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17101 PRESTON RD",
            "address_2": "STE 115",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481331",
            "telephone_number": "214-984-3900",
            "fax_number": "972-294-3343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17101 PRESTON RD",
            "address_2": "STE 115",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481331",
            "telephone_number": "214-984-3900",
            "fax_number": "972-294-3343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIAQ TEXAS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIAQ LLC",
        "enumeration_date": "2015-09-01",
        "last_updated": "2015-09-01",
        "status": "A",
        "authorized_official_last_name": "OSULLIVAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "21498439000"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0222X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": "TX",
            "license": "226944",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Pederson, LCSW
• Pedi-Ortho Health Corporation
• Pediacare of Texas Inc
• Pediapex Heart Center for Children PA
• Pediaq
• Pediatric Acute Care Associates of N.TX, PLLC
• Pediatric Acute Care Associates of North Texas, PLLC
• Pediatric Allergy Immunology Assoc.,P.a.
• Pediatric Anesthesia Associates
• Pediatric Associates of Dallas

• Pediatric Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Pediatric Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; 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.