Provider Demographics
NPI:1245456276
Name:WEST TEXAS PEDIATRIC CARDIOLOGY
Entity type:Organization
Organization Name:WEST TEXAS PEDIATRIC CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOMKID
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIDAROMONT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-791-5930
Mailing Address - Street 1:3702 20TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1206
Mailing Address - Country:US
Mailing Address - Phone:806-791-5930
Mailing Address - Fax:806-791-5937
Practice Address - Street 1:3702 20TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1206
Practice Address - Country:US
Practice Address - Phone:806-791-5930
Practice Address - Fax:806-791-5937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty