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FAIRWAY PEDIATRICS, PLLC
NPI 1821340472
Pediatrics in Carrollton, TX

Active since October 06, 2012CLIA 45D2043422 · Waiver
4100 FAIRWAY DR, SUITE 300, CARROLLTON, TX 75010(972) 492-8880(972) 492-8818 Get Directions Write a Review

NPPES record last updated: January 7, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Fairway Pediatrics, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAIRWAY PEDIATRICS, PLLC (NPI 1821340472) is a healthcare organization registered as a pediatrics in Carrollton, Texas and active in the NPI registry since October 2012. The organization holds a CLIA Waiver certificate valid through July 1, 2028 and lists Jian Wang, Owner, as its authorized official.

NPPES Registry Identity

NPI1821340472
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameFAIRWAY PEDIATRICS, PLLC
Location Address4100 FAIRWAY DR, SUITE 300Carrollton, TX 75010-6525
Mailing Address4100 Fairway Dr, Suite 300Carrollton, TX 75010-6525 · (972) 492-8880 · Fax (972) 492-8818
Phone(972) 492-8880
Fax(972) 492-8818
Organization SubpartNo
Authorized OfficialJian WangOwner · (469) 855-2073
Enumeration DateOctober 6, 2012
Last NPPES UpdateJanuary 7, 2013
✔ NPI 1821340472 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in TX · K6737
Definition
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.
4100 FAIRWAY DR, Carrollton, TX 75010
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Other Identifiers 1

Medicaid3079857-01TX

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2043422

Fairway Pediatrics, PLLC · Carrollton, TX
Active · expires Jul 1, 2028
CLIA Number45D2043422
Laboratory TypePhysician Office
Certificate Effective DateJuly 2, 2026
Certificate Expiration DateJuly 1, 2028
Laboratory DirectorJian Wang
Laboratory Phone(469) 855-2073
Laboratory LocationFairway Pediatrics, PLLC4100 Fairway Drive, Suite 300, Carrollton, TX 75010
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SUMMIT BEHAVIORAL HEALTH PLLC
Psychiatry & Neurology (Psychiatry)
4100 FAIRWAY DR, BLDG # 200
CARROLLTON, TX 75010
Denton County (972) 655-9121
AMANDA M WARNEKE
Physician Assistant
4100 FAIRWAY DR, SUITE 100
CARROLLTON, TX 75010
Denton County (844) 434-7627
MRS. ALISON JENNIFER TAYLOR OTR/L,CHT,CKTI
Occupational Therapist (Hand)
4100 FAIRWAY DR, STE 400
CARROLLTON, TX 75010
Denton County (972) 394-3325
FAIRWAY FAMILY MEDICINE-PRIMARY CARE, PLLC
Clinic/Center (Primary Care)
4100 FAIRWAY DR, 320
CARROLLTON, TX 75010
Denton County (972) 236-7608
CHARLES STEVEN MANLEY PH.D.
Psychologist
4100 FAIRWAY DR, STE. 200
CARROLLTON, TX 75010
Denton County (972) 221-1741
JIAN WANG MD
Pediatrics
4100 FAIRWAY DR, SUITE 300
CARROLLTON, TX 75010
Denton County (972) 492-8880
MS. KRISTA L KETCHAM M.ED., LPC
Counselor (Professional)
4100 FAIRWAY DR, SUITE 200
CARROLLTON, TX 75010
Denton County (214) 502-0991
DR. LISA RENEE REZNICK M.D.
Orthopaedic Surgery (Hand Surgery)
4100 FAIRWAY DR, SUITE 120
CARROLLTON, TX 75010
Denton County (972) 395-9000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fairway Pediatrics, PLLC's NPI number?

The NPI number for Fairway Pediatrics, PLLC is 1821340472. It was assigned to this organization in the NPPES registry on October 6, 2012.

Where is Fairway Pediatrics, PLLC located?

Fairway Pediatrics, PLLC is located at 4100 Fairway Dr Suite 300, Carrollton, TX 75010. The listed phone number is (972) 492-8880.

What is Fairway Pediatrics, PLLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Fairway Pediatrics, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2043422) is associated with this NPI, valid through July 1, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Fairway Pediatrics, PLLC was last updated on January 7, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.