MED-PEDS ASSOCIATESP.C. NPI 1063538312

NPI Information

  • NPI: 1063538312
  • Provider Name: MED-PEDS ASSOCIATES,P.C.
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • Address: 375 N WALL ST
    STE P520
    KANKAKEE, IL
    ZIP 60901
  • Phone: (815) 933-0194

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NPI Details

MED-PEDS ASSOCIATES,P.C. is a pediatrics in Kankakee, IL. 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. MED-PEDS ASSOCIATES,P.C. NPI is 1063538312. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

375 N WALL ST
STE P520
KANKAKEE, IL
ZIP 60901-483
Phone: (815) 933-0194
Fax: (815) 933-1444

The provider's authorized official is Stonewall Mccuiston .
The authorized official title is President and has the following contact phone number (815) 933-0194.

The enumeration date for this NPI number is 3/21/2007 and was last updated on 10/20/2010.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207R00000XInternal Medicine036074737ILLINOISNo
2208000000XPediatrics036074737ILLINOISYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
14623239OTHERILLINOISBLUE CROSS/BLUE SHIELD OF ILLINOIS
2CH9254MEDICARE PINILLINOIS
3036074737MEDICAIDILLINOIS
4562100MEDICARE PINILLINOIS
5=========-60901-01MEDICAIDILLINOIS
6E19358MEDICARE UPINILLINOIS

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: 3/30/2025

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