Medina Valley Pediatrics, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

AP115944 Issued in TX

Legal business name

MEDINA VALLEY PEDIATRICS, PLLC

Practice address

1028 Country LN
Castroville, TX 78009-5027

Phone

(210) 232-6464

NPI assigned

Feb 21, 2017

Last updated

Aug 7, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Katie Sue Russell, RN, MSN, CPNP

Title

President

Phone

(830) 355-2732

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1487635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502064000000",
    "number": "1568901619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 COUNTRY LANE",
            "city": "CASTROVILLE",
            "state": "TX",
            "postal_code": "78009",
            "telephone_number": "830-355-2732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 COUNTRY LN",
            "city": "CASTROVILLE",
            "state": "TX",
            "postal_code": "780095027",
            "telephone_number": "210-232-6464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDINA VALLEY PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-21",
        "last_updated": "2017-08-07",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "830-355-2732",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, MSN, CPNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "AP115944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medcare Imaging PLLC
• Medina County Hospital District (Medical Clinic of Castroville)
• Medina County Hospital District (Medina Valley Health & Rehabilitation Center)
• Medina Valley EMS Incorporated (Medina County EMS)
• Medina Valley Isd
• Medina Valley Spine and Joint, LLC
• Eloy Medina Medina
• Bernabe Isaac Mercado, PT, DPT
• Emily Sullivan Meyer, M.D.
• John Walter Meyer, M.D.

• Primary Care Clinic/Center in Castroville, TX
• Providers in Castroville, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2017; 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.