University Pediatric Childrens Foundation

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

UNIVERSITY PEDIATRIC CHILDRENS FOUNDATION

Practice address

1602 Rock Prairie Rd
Suite 310
College Station, TX 77845-8306

Phone

(979) 764-8308

NPI assigned

Aug 27, 2009

Last updated

Jun 20, 2012By 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

Amy Baldobino, CPC

Title

Credentialing Coordinator

Phone

(979) 696-4440

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• UPA Too Other name

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

{
    "created_epoch": "1251331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340150400000",
    "number": "1093948887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 ROCK PRAIRIE RD",
            "address_2": "SUITE 310",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458306",
            "telephone_number": "979-764-8308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 ROCK PRAIRIE RD",
            "address_2": "SUITE 310",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458306",
            "telephone_number": "979-764-8308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PEDIATRIC CHILDRENS FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-27",
        "last_updated": "2012-06-20",
        "status": "A",
        "authorized_official_last_name": "BALDOBINO",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "979-696-4440",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206345501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UPA Too",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jeffrey Lee Tyler, PA-C
• Katharine Tyson
• Chaiss Matthews Ugarte, MD
• Umd Health PLLC
• University Pediatric Association
• University Radiology Services, PA
• Urban Optics, PLLC
• Usv Optical Inc.
• Tamisha Lynette Utermark, PH.D.
• Kali Utsey, L.A.T.

• Pediatrics Physician in College Station, TX
• Providers in College Station, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; 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.