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UPA PLLC CHILD DEV CLINIC NPI 1841343605


NPI Information

NPI: 1841343605
Provider Name: UPA PLLC CHILD DEV CLINIC
Classification: Pediatrics - 2080P0006X
Entity Type: Organization

Specialization: Developmental - Behavioral Pediatrics

Address:
2500 N STATE ST
JACKSON, MS
ZIP 39216
Phone: (601) 984-5274
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UPA PLLC CHILD DEV CLINIC is a developmental - behavioral pediatrics pediatrics in Jackson, MS. The provider is a developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development. UPA PLLC CHILD DEV CLINIC NPI is 1841343605. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2500 N STATE ST
JACKSON, MS
ZIP 39216-500
Phone: (601) 984-5274

The provider's authorized official is Owen B Evans .
The authorized official title is Manager and has the following contact phone number (601) 984-5214.

The enumeration date for this NPI number is 1/18/2007 and was last updated on 6/24/2008.


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
12080P0006XPediatricsDevelopmental - Behavioral PediatricsYes

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
109014110MEDICAIDMISSISSIPPI
2C02166MEDICARE ID-TYPE UNSPECIFIEDMISSISSIPPIMEDICARE

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: 11/14/2023

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