PEDIATRIC CLINIC (NPI# 1649522616) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649522616 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC CLINIC |
| Practice Address |
3604 Cumberland Ave Middlesboro KY 40965-2614 |
| Mailing Address |
3604 West Cumberland Avenue Middlesboro KY 40965 |
| Practice Telephone | 6062488282 |
| Practice Fax Number | 6062480030 |
| Mailing Telephone | 6062488282 |
| Mailing Fax Number | 6062480030 |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2012-10-15 |
| Authorized Official Name | DR. HOUSHANG KHORRAM (DOCTOR) |
| Authorized Official Telephone | 6062488282 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 164526 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 0095596 | 05 | |
| KY | 16526 | 05 | |
| VA | 005628491 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952561805 | Pediatric Clinic | Point of Service | 32124 1st Ave S Ste 100, Federal Way, WA 98003-5761 | 2008-06-13 |
| 1497880181 | Pediatric Clinic | Pediatrics | 12351 Industriplex Blvd, Baton Rouge, LA 70809-5125 | 2007-02-22 |
| Street Address |
3604 CUMBERLAND AVE |
| City | MIDDLESBORO |
| State | KY |
| Zip Code | 40965-2614 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396387064 | Christopher Bruce Ellison | Social Worker | 809 19th Street, Middlesboro, KY 40965 | 2019-10-14 |
| 1982255030 | Johnny Wade Nantz II | Case Manager/Care Coordinator | 809 N 19th St, Middlesboro, KY 40965 | 2019-09-20 |
| 1558827774 | August Pediatrics, LLC | Pediatrics | 123 N 19th St Ste 302, Middlesboro, KY 40965 | 2019-02-12 |
| 1558843227 | Bethany Lauren Wade | Case Manager/Care Coordinator | 19th St, 809, Middlesboro, KY 40965 | 2018-08-30 |
| 1124521505 | Sonya Joyce Mcneil | Speech-Language Pathologist | Kidabilities Pediatric Therapy Center, 2801 Highway 25e, Suite 98, Middlesboro, KY 40965 | 2018-03-13 |
| 1518499862 | Vikki Lynn Johnson | Case Manager/Care Coordinator | 809 North 19th Street, Middlesboro, KY 40965 | 2017-03-28 |
| 1184164287 | Wilson Jeffrey | Occupational Therapist | Address: 235 New Wilson Lane, Middlesboro, KY 40965 | 2017-03-08 |
| 1447797444 | Lesha Loretta Williams | Physician Assistant | 2004 Cumberland Ave Ste 100, Middlesboro, KY 40965 | 2017-01-27 |
| 1619423910 | Audra Anissa Hall | Physical Therapist | 108 Turner Lane, Middlesboro, KY 40965 | 2016-08-28 |
| 1700332061 | Tammy Mclain | Counselor | Selfrefind 809 North 19th Street, Middlesboro, KY 40965 | 2016-08-28 |
| Find all providers in zip 40965 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558827774 | August Pediatrics, LLC | Pediatrics | 123 N 19th St Ste 302, Middlesboro, KY 40965 | 2019-02-12 |
| 1306185798 | Stallworth Internal Medicine and Pediatrics | Pediatrics | 2010 Cumberland Ave, Middlesboro, KY 40965-2829 | 2013-02-06 |
| 1518235563 | Bright Future Primary Care, Inc. | Pediatrics | 3602 West Cumberland Ave., Ste. B-102, Middlesboro, KY 40965 | 2011-12-06 |
| 1568463834 | Mohamad Hakam Alnahhas | Pediatrics | 3602 Cumberland Ave Ste B-102, Middlesboro, KY 40965-2614 | 2005-08-09 |
| 1083118673 | Rachel Andrea Jones-tackett | Pediatrics | 3602 Cumberland Ave Ste B102, Middlesboro, KY 40965-2614 | 2018-03-20 |
| 1386817773 | Sunrise Pediatrics Pllc | Pediatrics | 3602 Cumberland Ave, Suite B103, Middlesboro, KY 40965-2614 | 2008-04-08 |
| 1124039953 | Deborah L. Gever | Pediatrics | 3600 Cumberland Ave, Middlesboro, KY 40965-2614 | 2006-08-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205452836 | Jenna M. Richards Do | Pediatrics | 793 Eastern Byp Ste 110, Richmond, KY 40475-2425 | 2020-06-19 |
| 1598384745 | Breckinridge Health Clinic | Pediatrics | 203b Fairgrounds Rd, Hardinsburg, KY 40143-2585 | 2020-04-08 |
| 1811533433 | Grace Community Health Center, Inc. | Pediatrics | 120 N Commonwealth Ave Ste 123&4, Corbin, KY 40701-6472 | 2019-11-19 |
| 1306316989 | Jacquee L Mcnear | Pediatrics | 801 Barret Avenue Suite 314, Louisville, KY 40204-1701 | 2018-11-27 |
| 1477059657 | Advanced Care Pediatric Centre Pllc | Pediatrics | 1000 E Lexington Ave Ste 31, Danville, KY 40422-1707 | 2018-04-05 |
| 1396268223 | Prasanna Kumar Gangishetti | Pediatrics | 800 Rose St Rm No Mn-118, Lexington, KY 40536 | 2017-07-23 |
| 1154855054 | John Michael Jansen | Pediatrics | 3320 Tates Creek Rd Ste 302, Lexington, KY 40502-3400 | 2017-04-18 |
| 1396286407 | Alvarado Medical Services Pllc | Pediatrics | 25 E Hickman St, Winchester, KY 40391-2448 | 2017-03-09 |
| 1407218589 | Caitlyn Anglin | Pediatrics | University of Kentucky 800 Rose St Rm Mn 118, Lexington, KY 40536-1356 | 2016-03-28 |
| 1982066296 | Jeremy Sites | Pediatrics | 230 S Central Ave, Somerset, KY 42501-2110 | 2016-03-25 |
| Find all providers with the same taxonomy | ||||
| City | MIDDLESBORO |
| Zip Code | 40965 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.