Pediatric Heroes Primary Care Clinic, PLLC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

Legal business name

PEDIATRIC HEROES PRIMARY CARE CLINIC, PLLC

Practice address

21970 Bulverde Rd
San Antonio, TX 78259-2178

Phone

(240) 605-3767

NPI assigned

Jan 12, 2021

Last updated

Jan 12, 2021By 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

Marlischa Hall

Title

Owner

Phone

(240) 605-3767

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marlischa Jackson

  • Nurse Practitioner
  • San Antonio, TX
  • NPI 1801399019

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1610409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610409600000",
    "number": "1790374932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20403 ENCINO LEDGE UNIT 592625",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782590869",
            "telephone_number": "240-605-3767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21970 BULVERDE RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782592178",
            "telephone_number": "240-605-3767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC HEROES PRIMARY CARE CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-12",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "MARLISCHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-605-3767"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry of San Antonio
• Pediatric Ear, Nose & Throat Institute of South Texas
• Pediatric Health Therapy, Inc
• Pediatric Home Healthcare, LLC
• Pediatric Hospital Care Associates
• Pediatric Infectious Diseases Associates PA
• Pediatric Inpatient Critical Care Services PA
• Pediatric Institute of Southwest Texas,P.a. (Kubena Pediatrics)

• Pediatric Nurse Practitioner in San Antonio, TX
• Providers in San Antonio, 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 Jan 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.