Organization Active NPI

Pedidocs PLLC

  • Pediatrics Physician
  • San Antonio, TX
National Provider Identifier
1164445516
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIDOCS PLLC
Practice address
9838 Westover Hills Blvd
San Antonio, TX 78251
Phone
(210) 733-4362
Fax
(210) 521-1517
NPI assigned
Jul 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Authorized official

Name
Amanda Gollehon
Title
Admin Assistant
Phone
(210) 733-4362

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

9838 Westover Hills Blvd
San Antonio, TX 78251

Mailing address

9838 Westover Hills Blvd
San Antonio, TX 78251
Phone (210) 733-4362

Other identifiers 1

IdentifierTypeStateIssuer
182628101MedicaidTX

National Provider Directory

National Provider Directory

Locations

9838 Westover Hills Blvd
San Antonio, TX 78251
Phone (210) 495-7334

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619568000000",
    "number": "1164445516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9838 WESTOVER HILLS BLVD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78251",
            "telephone_number": "210-733-4362",
            "fax_number": "210-521-1517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9838 WESTOVER HILLS BLVD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78251",
            "telephone_number": "210-733-4362",
            "fax_number": "210-521-1517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIDOCS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A",
        "authorized_official_last_name": "GOLLEHON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "ADMIN ASSISTANT",
        "authorized_official_telephone_number": "210-733-4362"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182628101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; 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.