NPIMap

Organization Active NPI

Crater Child Development Clinic

  • Public Health or Welfare Agency
  • Petersburg, VA
National Provider Identifier
1164468823
Registry record updated Aug 22, 2020
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Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
CRATER CHILD DEVELOPMENT CLINIC
Practice address
2002 Wakefield Street
Petersburg, VA 23805-2112
Phone
(804) 862-6186
Fax
(804) 862-6276
NPI assigned
Jun 21, 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
Dr. Michael Owen Royster, MD
Title
District Health Director
Phone
(804) 863-1663

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X VA Primary

Addresses

Primary practice location

2002 Wakefield Street
Petersburg, VA 23805-2112

Mailing address

2002 Wakefield Ave
Petersburg, VA 23805-2112
Phone (804) 862-6186

National Provider Directory

National Provider Directory
Tax ID family
Dickenson Co Health Dep163 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164468823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 WAKEFIELD AVE",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052112",
            "telephone_number": "804-862-6186",
            "fax_number": "804-862-6276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 WAKEFIELD STREET",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052112",
            "telephone_number": "804-862-6186",
            "fax_number": "804-862-6276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRATER CHILD DEVELOPMENT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROYSTER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "OWEN",
        "authorized_official_title_or_position": "DISTRICT HEALTH DIRECTOR",
        "authorized_official_telephone_number": "804-863-1663",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

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.