NPIMap

Organization Active NPI

Medicci Klinx Inc.

  • Pediatrics Physician
  • Valparaiso, IN
National Provider Identifier
1043513294
Registry record updated Dec 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
01068033A Issued in IN
Legal business name
MEDICCI KLINX INC.
Practice address
1608 Lincolnway Ste C
Valparaiso, IN 46383-5852
Phone
(219) 299-2075
NPI assigned
Dec 9, 2010
Last updated
Dec 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2010

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

Authorized official

Name
Dr. Omar Villarroel, MD
Title
President
Phone
(912) 658-1155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 01068033A IN Primary

Addresses

Primary practice location

1608 Lincolnway Ste C
Valparaiso, IN 46383-5852

Mailing address

1608 Lincolnway Ste C
Valparaiso, IN 46383-5852
Phone (219) 299-2075

National Provider Directory

National Provider Directory

Locations

1608 Lincolnway
Ste C
Valparaiso, IN 46383
Phone (219) 299-2075

NPI Registry JSON

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

{
    "created_epoch": "1291852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291852800000",
    "number": "1043513294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1608 LINCOLNWAY STE C",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463835852",
            "telephone_number": "219-299-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1608 LINCOLNWAY STE C",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463835852",
            "telephone_number": "219-299-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICCI KLINX INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-09",
        "last_updated": "2010-12-09",
        "status": "A",
        "authorized_official_last_name": "VILLARROEL",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-658-1155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01068033A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valparaiso, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; 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.