PRIMARY CARE PEDIATRICSPA NPI 1417006735

NPI Information

  • NPI: 1417006735
  • Provider Name: PRIMARY CARE PEDIATRICS,PA
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • CLIA Number: 45D1059554
  • Address: 8333 9TH AVE.
    SUITE B
    PORT ARTHUR, TX
    ZIP 77642
  • Phone: (409) 729-9200

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NPI Details

PRIMARY CARE PEDIATRICS,PA is a pediatrics in Port Arthur, TX. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. PRIMARY CARE PEDIATRICS,PA NPI is 1417006735. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

8333 9TH AVE.
SUITE B
PORT ARTHUR, TX
ZIP 77642
Phone: (409) 729-9200
Fax: (409) 729-9235

The provider's authorized official is Minda Lao Toledo .
The authorized official title is President and has the following contact phone number (409) 729-9200.

The CLIA number assigned to this NPI record is 45D1059554 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/9/2007 and was last updated on 6/24/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsM2487TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1M2487OTHERTEXASTEXAS LICENSE
2I47897MEDICARE UPINTEXAS
3178297101MEDICAIDTEXAS
400953ZMEDICARE ID-TYPE UNSPECIFIEDTEXAS
5178296301MEDICAIDTEXAS
6178296302MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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