PEDIAQ LLC (NPI# 1255885745) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255885745 |
| Entity Type | Organization |
| Organization Name | PEDIAQ LLC |
| Practice Address |
10413 Walpole Ln Austin TX 78739-1553 |
| Mailing Address |
4849 Greenville Ave Ste 1225 Dallas TX 75206-4130 |
| Practice Telephone | 3107134847 |
| Mailing Telephone | 2149843900 |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2016-08-12 |
| Authorized Official Name | DR. FRED JOHNSON (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 2149843900 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
AP81285 | TX | Ambulatory Health Care Facilities |
| Street Address |
10413 WALPOLE LN |
| City | AUSTIN |
| State | TX |
| Zip Code | 78739-1553 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679029045 | Chanin Mcclurkin | Nurse Practitioner | 10413 Walpole Ln, Austin, TX 78739-1553 | 2016-08-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871002188 | Cole Stutz | Physical Therapist | 5401 La Crosse Ave., Building C, Suite 101, Austin, TN 78739 | 2017-09-29 |
| 1346796992 | Amanda Sylvie | Dietitian, Registered | 6604 Nusser Ln, Austin, TX 78739 | 2016-09-01 |
| 1609259431 | Marjan Aryannejad | Pharmacist | 10805 Tollesboro Cove, Austin, TX 78739 | 2015-06-29 |
| 1780071563 | Lauren Vaughn | Counselor | 11228 South Bay Lane, Austin, TX 78739 | 2015-04-20 |
| 1649552860 | Purvi Patel | Pharmacist | 12212 Tuberose Ter, Austin, TX 78739 | 2011-09-14 |
| 1780915124 | Stephanie Ann Etie | Behavioral Analyst | 5924 Rickerhill Ln, Austin, TX 78739 | 2010-01-25 |
| 1972724730 | Qiao Xu | Acupuncturist | 11236 South Bay Lane, Austin, TX 78739 | 2007-05-01 |
| 1740382084 | Ferril Chris Smith | Internal Medicine | 4104 Reynosa Dr, Austin, TX 78739 | 2006-09-05 |
| 1295235992 | Sally Elizabeth Stroud | Registered Nurse | 6405 Back Bay Ln, Austin, TX 78739-1402 | 2018-02-19 |
| 1982262317 | Adrienne Lee Wiggins | Registered Nurse | 6407 Old Harbor Ln, Austin, TX 78739-1405 | 2019-05-31 |
| Find all providers in zip 78739 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043704620 | Lankford Md Pllc | Clinic/Center | 3117 Wild Canyon Loop, Austin, TX 78732-1948 | 2018-06-18 |
| 1861812547 | Hill Family Medicine & Skin Care Pa | Clinic/Center | 11420 Bee Cave Rd, Ste A150, Austin, TX 78738 | 2014-04-22 |
| 1780987347 | Tony Dang M.d., P.a. | Clinic/Center | 14019 Lakeview Dr, Austin, TX 78732-1048 | 2010-12-20 |
| 1962689950 | E David Pampe, M.d. | Clinic/Center | 6012 West William Cannon Dr Ste D101, Austin, TX 78749-1979 | 2008-01-22 |
| 1841476272 | Kids Choice P.a. | Clinic/Center | 2113 Wells Branch Pkwy, Suite 1200, Austin, TX 78728-6970 | 2008-01-16 |
| 1851519326 | Access Co-medical Clinic | Clinic/Center | 2919 Manchaca Rd Ste 100-a, Austin, TX 78704-4817 | 2007-04-23 |
| 1467581900 | Enrique Antonio Martinez | Clinic/Center | 809 Lydia St, Austin, TX 78702-2622 | 2007-03-02 |
| 1477661155 | Kevin P. Spencer, Md, Pa | Clinic/Center | 8100 Cobblestone, Austin, TX 78735-7902 | 2006-08-25 |
| 1972133544 | Tarrytown Pharmacy | Clinic/Center | 2727 Exposition Blvd Ste 105, Austin, TX 78703-1227 | 2020-01-22 |
| 1154960102 | Remedy Clinics of Texas Pa | Clinic/Center | 851 W 6th St, Austin, TX 78703-5403 | 2019-12-22 |
| Find all providers in AUSTIN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.