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CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE PA NPI 1437102381


NPI Information

NPI: 1437102381
Provider Name: CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE, PA
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 34D1016675

Address:
136 GATEWAY BLVD STE A
MOORESVILLE, NC
ZIP 28117
Phone: (704) 799-2878
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CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE, PA is a pediatrics in Mooresville, NC. 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. CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE, PA NPI is 1437102381. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

136 GATEWAY BLVD STE A
MOORESVILLE, NC
ZIP 28117-608
Phone: (704) 799-2878
Fax: (704) 799-1627

The provider's authorized official is Elizabeth Ellen Tilt .
The authorized official title is President and has the following contact phone number (704) 799-2878.

The CLIA number assigned to this NPI record is 34D1016675 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/19/2006 and was last updated on 7/24/2013.


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
1208000000XPediatrics118445NORTH CAROLINAYes

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
189015J3MEDICAIDNORTH CAROLINA

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

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