Provider Demographics
NPI:1053737833
Name:PEDIATRIC OFFICES AT WILLOW BEND ASSOCIATION
Entity type:Organization
Organization Name:PEDIATRIC OFFICES AT WILLOW BEND ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-781-1414
Mailing Address - Street 1:6529 W PLANO PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8260
Mailing Address - Country:US
Mailing Address - Phone:972-781-1414
Mailing Address - Fax:972-781-1717
Practice Address - Street 1:6529 W PLANO PKWY STE B
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8260
Practice Address - Country:US
Practice Address - Phone:972-781-1414
Practice Address - Fax:972-781-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8509261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care