NPIMap

Organization Active NPI

Pediatric Associates Prof LLC

Doing business as Teen Care Center

  • Pediatric Adolescent Medicine Physician
  • Montrose, CO
National Provider Identifier
1033614334
Registry record updated Mar 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
PEDIATRIC ASSOCIATES PROF LLC
Doing business as
Teen Care Center
Practice address
910 S 4TH St
Montrose, CO 81401-4226
Phone
(970) 249-2421
Fax
(970) 249-1203
NPI assigned
Mar 28, 2018
Last updated
Mar 28, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
PEDIATRIC ASSOCIATES PROF LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 28, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amber Hickert
Title
Practice Administrator
Phone
(970) 249-2421

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X NU Primary

Addresses

Primary practice location

910 S 4TH St
Montrose, CO 81401-4226

Mailing address

947 S 5TH St
Montrose, CO 81401-5716
Phone (970) 249-2421

Other names 1

  • Teen Care Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Associates Prof LLC3 organizations share this tax ID, including this one
Part of
Pediatric Associates Prof LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

910 S 4th St
Montrose, CO 81401
Phone (970) 249-2421

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11212/brand/1/csg/1/fhir/r4

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522195200000",
    "number": "1033614334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "947 S 5TH ST",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814015716",
            "telephone_number": "970-249-2421",
            "fax_number": "970-249-1203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 S 4TH ST",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814014226",
            "telephone_number": "970-249-2421",
            "fax_number": "970-249-1203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES PROF LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC ASSOCIATES PROF LLC",
        "enumeration_date": "2018-03-28",
        "last_updated": "2018-03-28",
        "status": "A",
        "authorized_official_last_name": "HICKERT",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "970-249-2421"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teen Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Teen Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montrose, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.