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PAVILION PEDIATRIC CENTER LLC NPI 1063887438


NPI Information

NPI: 1063887438
Provider Name: PAVILION PEDIATRIC CENTER, LLC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 15D0360049

Address:
2525 W UNIVERSITY AVE
SUITE 404
MUNCIE, IN
ZIP 47303
Phone: (765) 231-9494
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PAVILION PEDIATRIC CENTER, LLC is a pediatrics in Muncie, IN. 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. PAVILION PEDIATRIC CENTER, LLC NPI is 1063887438. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2525 W UNIVERSITY AVE
SUITE 404
MUNCIE, IN
ZIP 47303-421
Phone: (765) 231-9494
Fax: (765) 587-4456

The provider's authorized official is Prakash Bhoopalam .
The authorized official title is Owner and has the following contact phone number (765) 231-9494.

The CLIA number assigned to this NPI record is 15D0360049 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/10/2015 and was last updated on 4/4/2016.


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
1208000000XPediatrics01040631AINDIANAYes

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
1201337310AMEDICAIDINDIANA
2100362560MEDICAIDINDIANA
3201328850MEDICAIDINDIANA

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.