| St. Jude's Family And Pediatric Clinic Pllc | |
|
5140 Montana Ave El Paso TX 79903-4904 | |
| (915) 544-8844 | |
| Not Available |
| Full Name | St. Jude's Family And Pediatric Clinic Pllc |
|---|---|
| Speciality | Pediatrics |
| Location | 5140 Montana Ave, El Paso, Texas |
| Authorized Official Name and Position | Annette C Griego (CEO) |
| Authorized Official Contact | 9155448844 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Jude's Family And Pediatric Clinic Pllc 5140 Montana Ave El Paso TX 79903-4904 Ph: (915) 204-3809 | St. Jude's Family And Pediatric Clinic Pllc 5140 Montana Ave El Paso TX 79903-4904 Ph: (915) 544-8844 |
| NPI Number | 1023775905 |
|---|---|
| Provider Enumeration Date | 11/26/2021 |
| Last Update Date | 03/02/2023 |
| Medicare PECOS PAC ID | 3779956826 |
|---|---|
| Medicare Enrollment ID | O20230310001368 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023775905 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
| Provider Name | Annette C Griego |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902093016 PECOS PAC ID: 9234215989 Enrollment ID: I20080321000105 |
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