| Kidscorner Pediatrics | |
|
2198 E Garrison St Eagle Pass TX 78852-5076 | |
| (830) 773-7662 | |
| (830) 773-7664 |
| Full Name | Kidscorner Pediatrics |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 2198 E Garrison St, Eagle Pass, Texas |
| Authorized Official Name and Position | Guillermo Augusto Urueta (OWNER) |
| Authorized Official Contact | 8307737662 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kidscorner Pediatrics 2198 E Garrison St Eagle Pass TX 78852-5076 Ph: (830) 773-7662 | Kidscorner Pediatrics 2198 E Garrison St Eagle Pass TX 78852-5076 Ph: (830) 773-7662 |
| NPI Number | 1073632188 |
|---|---|
| Provider Enumeration Date | 03/28/2007 |
| Last Update Date | 01/15/2025 |
| Certification Date | 01/15/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073632188 | NPI | - | NPPES |
| E01008299 | Other | DPS NUMBER | |
| 179181601 | Medicaid | TX | |
| K6379 | Other | TX | STAE MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (NU) | Primary |
| 174400000X | Specialist | (NU) | Secondary |
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