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CLOWN PEDIATRICS NPI 1669674461


NPI Information

NPI: 1669674461
Provider Name: CLOWN PEDIATRICS
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 15D1029507

Address:
401 CAMBY CT
GREENWOOD, IN
ZIP 46142
Phone: (317) 881-8737
Get Directions

CLOWN PEDIATRICS is a specialist in Greenwood, IN. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. CLOWN PEDIATRICS NPI is 1669674461. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

401 CAMBY CT
GREENWOOD, IN
ZIP 46142-085
Phone: (317) 881-8737
Fax: (317) 881-8735

The provider's authorized official is Jeremy Wade Roscoe .
The authorized official title is Physician and has the following contact phone number (317) 881-8737.

The CLIA number assigned to this NPI record is 15D1029507 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/4/2007 and was last updated on 5/9/2011.


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
1174400000XSpecialist1057187 AINDIANAYes

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
1200479420 AMEDICAIDINDIANA

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: 5/5/2024

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.