1932234788 NPI number — PEDIATRICS PLUS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932234788 NPI number — PEDIATRICS PLUS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRICS PLUS, 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:
PEDS PLUS
Provider Other Organization Name Type Code:
5
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:
1932234788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 903
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIXSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37343-0903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-894-4774
Provider Business Mailing Address Fax Number:
423-894-4775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4295 CROMWELL RD
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37421-2166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-894-4774
Provider Business Practice Location Address Fax Number:
423-894-4775
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STEELE
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
423-894-4774

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00446653 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3156781 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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