Children's Clinic of Jasper

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

H4321 Issued in TX

Legal business name

CHILDREN'S CLINIC OF JASPER

Practice address

1008 Dickerson Dr
Jasper, TX 75951-5111

Phone

(936) 634-2214

Fax

(936) 639-9660

NPI assigned

Jul 14, 2016

Last updated

Jul 14, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Chere Crocker

Title

Office Manager

Phone

(936) 634-2214

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1468454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468454400000",
    "number": "1093168049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150638",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759150638",
            "telephone_number": "936-634-2214",
            "fax_number": "936-639-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 DICKERSON DR",
            "city": "JASPER",
            "state": "TX",
            "postal_code": "759515111",
            "telephone_number": "936-634-2214",
            "fax_number": "936-639-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S CLINIC OF JASPER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-14",
        "last_updated": "2016-07-14",
        "status": "A",
        "authorized_official_last_name": "CROCKER",
        "authorized_official_first_name": "CHERE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "936-634-2214"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "H4321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191679301",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092130602",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chancees Consulting and Management LLC (Total Health Family Medicine)
• Chartwell Community Service, Inc (Elara Caring)
• Chartwell Community Service, Inc (Jordan Health Service, a Part of the Elara Caring Network)
• Chartwell Community Services, Inc. (Elara Caring)
• Kasim Chaudhry, FNP
• Christus Health Southeast Texas (CHRISTUS Southeast Texas Family Practice and Women's Services Center)
• Christus Health Southeast Texas (Christus Southeast Texas Family Practice Center - Jasper)
• Christus Health Southeast Texas (CHRISTUS Southeast Texas - Jasper Memorial)
• Christus Health Southeast Texas (CHRISTUS Jasper Memorial Hospital)
• Christus Health Southeast Texas (CHRISTUS Jasper Memorial Hospital)

• Pediatrics Physician in Jasper, TX
• Providers in Jasper, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; 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.