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PEDIATRIC GROUP OF PADUCAH NPI 1346279510


NPI Information

NPI: 1346279510
Provider Name: PEDIATRIC GROUP OF PADUCAH
Classification: Pediatrics - 208000000X
Entity Type: Organization
Address:
2605 KENTUCKY AVE
BLDG 3 SUITE 501
PADUCAH, KY
ZIP 42003
Phone: (270) 443-7534
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PEDIATRIC GROUP OF PADUCAH is a pediatrics in Paducah, KY. The provider is 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. PEDIATRIC GROUP OF PADUCAH NPI is 1346279510. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2605 KENTUCKY AVE
BLDG 3 SUITE 501
PADUCAH, KY
ZIP 42003-800
Phone: (270) 443-7534

The provider's authorized official is Dana L Evans .
The authorized official title is Provider Enrollment Specialist and has the following contact phone number (270) 744-9600.

The enumeration date for this NPI number is 7/1/2006 and was last updated on 8/5/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363LF0000XNurse PractitionerFamily3007447KENTUCKYNo
2208000000XPediatrics28040KENTUCKYNo
3208000000XPediatrics30516KENTUCKYNo
4208000000XPediatrics22172KENTUCKYNo
5208000000XPediatrics43274KENTUCKYNo
6208000000XPediatrics20596KENTUCKYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
165923377MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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