Premium Pediatrics PLLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

PREMIUM PEDIATRICS PLLC

Practice address

307 E Broadway St
Campbellsville, KY 42718-2003

Phone

(270) 789-4788

Fax

(270) 572-4227

NPI assigned

Nov 28, 2006

Organization subpart

No

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

Authorized official

Name

Dan G. Bodeanu, MD

Title

Physician and Owner

Phone

(270) 789-4788

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218412800000",
    "number": "1174699359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 E BROADWAY ST",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427182003",
            "telephone_number": "270-789-4788",
            "fax_number": "270-572-4227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 E BROADWAY ST",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427182003",
            "telephone_number": "270-789-4788",
            "fax_number": "270-572-4227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM PEDIATRICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2008-08-11",
        "status": "A",
        "authorized_official_last_name": "BODEANU",
        "authorized_official_first_name": "DAN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PHYSICIAN AND OWNER",
        "authorized_official_telephone_number": "270-789-4788",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64128457",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50013851",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Campbellsville, KY
• Providers in Campbellsville, KY by specialty
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2008; 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.