Pediatric Gastroenterology PSC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

0424168 Issued in KY

Legal business name

PEDIATRIC GASTROENTEROLOGY PSC

Practice address

233 E Gray St
Suite 513
Louisville, KY 40202-2026

Phone

(502) 629-5796

Fax

(502) 629-5799

NPI assigned

Jul 8, 2006

Last updated

May 19, 2022By 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

Thgmas C Stephen, M.D

Title

President

Phone

(502) 629-5796

Specialties & licenses 1

Addresses

Other identifiers 3

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.

• Thomas C Stephen, MD

  • Pediatric Gastroenterology Physician
  • Louisville, KY
  • NPI 1922082460
  NPD (past)

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652918400000",
    "number": "1164455952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 E GRAY ST",
            "address_2": "SUITE 513",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402022026",
            "telephone_number": "502-629-5796",
            "fax_number": "502-629-5799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 E GRAY ST",
            "address_2": "SUITE 513",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402022026",
            "telephone_number": "502-629-5796",
            "fax_number": "502-629-5799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC GASTROENTEROLOGY PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2022-05-19",
        "status": "A",
        "authorized_official_last_name": "STEPHEN",
        "authorized_official_first_name": "THGMAS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-629-5796",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "KY",
            "license": "0424168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65927816",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200140610A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT GROUP NUMBER",
            "identifier": "1049092",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dental Group of Louisville
• Pediatric Heartcare Partners PSC
• Pediatric Hematology-Oncology Specialists, PSC
• Pediatric Hematology/Oncology Specialists
• Pediatric Hematology/Oncology Specialists, PSC
• Pediatric Partners of Jeffersontown

• Clinic/Center in Louisville, KY
• Providers in Louisville, KY by specialty
• Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; 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.