WACO NEONATAL GROUP, P.A. (NPI# 1265530604) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265530604 |
| Entity Type | Organization |
| Organization Name | WACO NEONATAL GROUP, P.A. |
| Practice Address |
100 Hillcrest Medical Blvd Waco TX 76712-8897 |
| Mailing Address |
3740 Chimney Ridge Dr Waco TX 76708-2368 |
| Practice Telephone | 2542022911 |
| Practice Fax Number | 2542022919 |
| Mailing Telephone | 2547540934 |
| Mailing Fax Number | 2547140650 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-04-18 |
| Authorized Official Name | DARRELL S WHEELER (PRESIDENT) |
| Authorized Official Telephone | 7547540934 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
H0927 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 110419201 | 05 |
| Street Address |
100 HILLCREST MEDICAL BLVD |
| City | WACO |
| State | TX |
| Zip Code | 76712-8897 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639177462 | Tamsak Kanoklukul | Nurse Anesthetist, Certified Registered | 100 Hillcrest Medical Blvd, Waco, TX 76712-8897 | 2005-07-14 |
| 1851992184 | Heather Ann Johnson | Registered Nurse | 100 Hillcrest Medical Blvd, Waco, TX 76712-8897 | 2020-11-03 |
| 1013542372 | Samuel Kelly | Anesthesiologist Assistant | 100 Hillcrest Medical Blvd, Waco, TX 76712-8897 | 2020-03-06 |
| 1902457047 | Megan R Fortenberry | Nurse Practitioner | 100 Hillcrest Medical Blvd, Waco, TX 76712-8897 | 2019-09-20 |
| 1275188732 | Betty Jean Gonzalez | Nurse Practitioner | 100 Hillcrest Medical Blvd, Waco, TX 76712-8897 | 2019-08-01 |
| 1073166559 | Ricardo G Altahif Jr. | Occupational Therapist | 100 Hillcrest Medical Blvd, Waco, TX 76712-8897 | 2019-07-23 |
| 1184286148 | Julia Melee Jones | Physician Assistant | 100 Hillcrest Medical Blvd, Waco, TX 76712-8897 | 2019-06-30 |
| 1194386870 | Daniel Roy Beane | Anesthesiologist Assistant | 100 Hillcrest Medical Blvd, Waco, TX 76712-8897 | 2019-06-24 |
| 1376100875 | Meryl Lee Boutte | Anesthesiology | 100 Hillcrest Medical Blvd, Waco, TX 76712-8897 | 2019-05-21 |
| 1982178018 | Kenneth James Roeger | Nurse Anesthetist, Certified Registered | 100 Hillcrest Medical Blvd, Waco, TX 76712 | 2019-01-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922634294 | Waco Ophthalmology, Pllc | Ophthalmology | 602 W Highway 6, Waco, TX 76712 | 2020-03-19 |
| 1326692872 | Oceans Behavioral Hospital of Waco LLC | Psychiatric Hospital | 5931 Crosslake Parkway, Waco, TX 76712 | 2019-08-01 |
| 1831759620 | Jessica Ngoc Vien | Optometrist | 1000 Hwy 6, Ste 210, Waco, TX 76712 | 2019-06-14 |
| 1780150888 | Chelsea Cannon | Occupational Therapist | 330 W State Hwy 6, Waco, TX 76712 | 2018-10-17 |
| 1669955399 | Elizabeth Ann Barnhill | Speech-Language Pathologist | 15003 Riatta Rd, Woodway, TX 76712 | 2018-09-09 |
| 1447731617 | Melanie A Melton | Physical Therapist | 300 West Highway 6, Waco, TX 76712 | 2018-08-27 |
| 1396226403 | Gala Kaye Czajkoski | Occupational Therapy Assistant | 300 West Hightway 6, Waco, TX 76712 | 2018-08-27 |
| 1619457454 | Monica Anderson | Physical Therapy Assistant | 300 W Hwy 6, Waco, TX 76712 | 2018-08-21 |
| 1295238368 | Waco Sn Opco LLC | Skilled Nursing Facility | 7501 Bagby, Waco, TX 76712 | 2018-03-14 |
| 1558872952 | C. Guy Fps, Pllc | Otolaryngology | 1129 Aberdeen Rd, Waco, TX 76712 | 2017-10-12 |
| Find all providers in zip 76712 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124241435 | Darrell Stafford Wheeler | Pediatrics | 100 Hillcrest Baptist Medical Blvd., Waco, TX 76712 | 2007-04-11 |
| 1497889984 | Daksha M Patel | Pediatrics | 3000 Herring Ave, Waco, TX 76708-3239 | 2007-03-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699233510 | Allison Claire Arbilo | Pediatrics | 6431 Fannin St # 3.254, Houston, TX 77030-1501 | 2019-03-10 |
| 1619469343 | Deulofeut Physician Services Pllc | Pediatrics | 1924 Pine St Ste 401b, Abilene, TX 79601-2452 | 2018-05-30 |
| 1801303979 | Gulf Coast Neonatology, Pllc | Pediatrics | 5920 Saratoga Blvd Ste 450, Corpus Christi, TX 78414-4124 | 2018-01-10 |
| 1023522331 | Richard Michael Rodriguez | Pediatrics | 2205 Concord Pl, Brownsville, TX 78520-3984 | 2017-11-22 |
| 1306266200 | Carlos A Laos, Md, Pa | Pediatrics | 25 Cochran Oaks Ln, Dallas, TX 75220-7811 | 2014-04-18 |
| 1225451032 | Sherlene Annette Dreyer | Pediatrics | 5000 Montrose Blvd Unit 19b, Houston, TX 77006-6564 | 2014-01-29 |
| 1154752418 | Dolores Carruth | Pediatrics | 2510 Skyline Dr, Irving, TX 75038-5819 | 2013-12-11 |
| 1891033981 | Lisa Jensen Mitchell | Pediatrics | Carl R. Darnall Medical Center, 2608 Marlin Dr, Killeen, TX 76543-2773 | 2013-01-23 |
| 1780940940 | Harashada Luhar | Pediatrics | 4707 Circle Oak Cv, Austin, TX 78749-2302 | 2012-04-02 |
| 1689954794 | Dharmendra Kumar | Pediatrics | Covenant Children's Hospital, 4000 24th Street, Lubbock, TX 79410 | 2011-08-19 |
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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.