1831493790 NPI number — PEDIATRIC SERVICES OF AMERICA, INC

Table of content: (NPI 1831493790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831493790 NPI number — PEDIATRIC SERVICES OF AMERICA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC SERVICES OF AMERICA, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PSA HEALTHCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831493790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/02/2014
NPI Reactivation Date:
06/04/2015

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 CONCOURSE PKWY NE
Provider Second Line Business Mailing Address:
STE 1100
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-6117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-441-1580
Provider Business Mailing Address Fax Number:
770-248-8192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6316 SAINT ANDREWS RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29212-3168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-454-9730
Provider Business Practice Location Address Fax Number:
803-454-9735
Provider Enumeration Date:
01/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MCCURRY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
770-441-1580

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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