Basic Information
| Provider Information | |||||||||
| NPI: | 1326062944 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS NEWBORN SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 CONCORD TERRACE | ||||||||
| Address2: | |||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543840175 | ||||||||
| FaxNumber: | 9548511948 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 E PRESIDENT GEORGE BUSH HWY | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750823542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724375099 | ||||||||
| FaxNumber: | 9727641661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 12/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | DWYER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 9543840175 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 00X509 | 01 | TX | MEDICARE | OTHER | 0005 | 01 | TX | TRICARE | OTHER | 00X507 | 01 | TX | MEDICARE | OTHER | 186853101 | 05 | TX | MEDICAID | 0067GW | 01 | TX | BCBS | OTHER | 200052430A | 05 | TX | MEDICAID | 0006 | 01 | TX | TRICARE | OTHER | 00X508 | 01 | TX | MEDICARE | OTHER | 183525803 | 05 | TX | MEDICAID | 00413Y | 01 | TX | MEDICARE | OTHER | 183525801 | 05 | TX | MEDICAID | 183525802 | 05 | TX | MEDICAID | 186765701 | 05 | TX | MEDICAID | 5539639 | 01 | TX | AETNA | OTHER |