NPIMap

Organization Active NPI

Pediatric Services of America, Inc.

Doing business as PSA Healthcare

  • Medically Fragile Infants and Children Day Care
  • Jacksonville, FL
National Provider Identifier
1164446530
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medically Fragile Infants and Children Day CareTaxonomy code 261QM3000X
License
PPC60080961 Issued in FL
Legal business name
PEDIATRIC SERVICES OF AMERICA, INC.
Doing business as
PSA Healthcare
Practice address
4051 Phillips Hwy
Suite 2
Jacksonville, FL 32207-9305
Phone
(904) 731-0030
Fax
(904) 731-0766
NPI assigned
Jul 27, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dale ValentineNPI 1306915590
Title
VP Compliance Officer
Phone
(770) 248-8757

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medically Fragile Infants and Children Day Care 261QM3000X PPC60080961 FL Primary

Addresses

Primary practice location

4051 Phillips Hwy
Suite 2
Jacksonville, FL 32207-9305

Mailing address

310 Technology Pkwy
Norcross, GA 30092-2932
Phone (770) 441-1580

Other names 1

  • PSA Healthcare Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Services of76 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164446530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 TECHNOLOGY PKWY",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300922932",
            "telephone_number": "770-441-1580",
            "fax_number": "770-248-8192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4051 PHILLIPS HWY",
            "address_2": "SUITE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322079305",
            "telephone_number": "904-731-0030",
            "fax_number": "904-731-0766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SERVICES OF AMERICA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VALENTINE",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "VP COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "770-248-8757"
    },
    "taxonomies": [
        {
            "code": "261QM3000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medically Fragile Infants and Children Day Care",
            "state": "FL",
            "license": "PPC60080961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PSA Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.