Vincent Adjetey, MD
Individual provider Active NPI Pediatrics Physician · Watford City, ND
NPI 1093200420 · NPPES record last updated Dec 13, 2021
Key facts
- NPI
- 1093200420
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 17144 (ND)
- Practice address
- 709 4TH Ave NE
Watford City, ND 58854-7628 - Phone
- (701) 842-3771
- Fax
- (701) 842-6248
- NPI assigned
- Jun 27, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210604000820 | ND | Practitioner - Pediatric Medicine | 4284033622 | |
| I20240422002272 | TX | Practitioner - Pediatric Medicine | 4284033622 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Children'S Clinic PA | Pediatrics | Current |
Accepting new patients |
| Children'S Physician Services of South Texas | Current |
Accepting new patients | |
| Children'S Physician Services of South Texas | Pediatrics | Current |
Accepting new patients |
Locations
3533 S Alameda St
Corpus Christi, TX 78411
Phone (361) 694-5445
3435 S Alameda St
Ste 200
Corpus Christi, TX 78411
4525 Ayers St
Corpus Christi, TX 78415
Phone (877) 324-7543
13725 Northwest Blvd
Ste 150
Corpus Christi, TX 78410
Phone (361) 241-9541
3435 S Alameda St
Corpus Christi, TX 78411
Phone (361) 855-7346
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 17144 | ND | Yes |
Addresses
Primary practice location
709 4TH Ave NE
Watford City, ND 58854-7628
Mailing address
709 4TH Ave NE
Watford City, ND 58854-7628
Phone (701) 842-3771
Other providers in Watford City, ND
- 5H, LLC
- Ashley Abbe
- Jennifer Abraham
- Valarie Alexander
- Aligned Family Chiropractic
- Julia Allen
- Anova Family Health Center Inc.
- Kendra Bohm
All providers in Watford City, ND · Pediatrics Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.