PEDIATRIC ASSOCIATES OF ELIZABETHTOWN PLLC NPI 1891855359

NPI Information

NPI: 1891855359
Provider Name: PEDIATRIC ASSOCIATES OF ELIZABETHTOWN, PLLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 18D0924189

Address:
111 HELMWOOD PLAZA DR
ELIZABETHTOWN, KY
ZIP 42701
Phone: (270) 737-4808
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PEDIATRIC ASSOCIATES OF ELIZABETHTOWN, PLLC is a primary care clinic center in Elizabethtown, KY. PEDIATRIC ASSOCIATES OF ELIZABETHTOWN, PLLC NPI is 1891855359. The provider is registered as an organization entity type.

The provider's business location address is:

111 HELMWOOD PLAZA DR
ELIZABETHTOWN, KY
ZIP 42701-480
Phone: (270) 737-4808

The provider's authorized official is Marquita H Ball .
The authorized official title is Partner and has the following contact phone number (270) 737-4808.

The CLIA number assigned to this NPI record is 18D0924189 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 12/12/2006 and was last updated on 12/1/2017.

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
1	261QP2300X	Clinic/Center	Primary Care			Yes

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
1	65929457	MEDICAID	KENTUCKY
2	1054638	OTHER	KENTUCKY	PASSPORT GROUP NUMBER

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

NPI Synchronization or Removal

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