RED MAPLE PEDIATRICS LLC NPI 1295461119

NPI Information

NPI: 1295461119
Provider Name: RED MAPLE PEDIATRICS LLC
Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

CLIA Number: 18D2268456

Address:
1621 NASHVILLE ST STE 106
RUSSELLVILLE, KY
ZIP 42276
Phone: (270) 946-1372
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RED MAPLE PEDIATRICS LLC is a rural health clinic center in Russellville, KY. RED MAPLE PEDIATRICS LLC NPI is 1295461119. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1621 NASHVILLE ST STE 106
RUSSELLVILLE, KY
ZIP 42276-871
Phone: (270) 946-1372
Fax: (270) 216-6185

The provider's authorized official is Danielle Kennedy-foster .
The authorized official title is Md and has the following contact phone number (270) 438-6622.

The CLIA number assigned to this NPI record is 18D2268456 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/25/2022 and was last updated on 2/26/2024.

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	Primary
1	363LF0000X	Nurse Practitioner	Family	No
2	208000000X	Pediatrics		No
3	261QR1300X	Clinic/Center	Rural Health	Yes

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

NPI Synchronization or Removal

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