NPIMap

Organization Active NPI

Pediatric Cardiology Services, LLC

  • Pediatric Cardiology Physician
  • Lawrenceville, GA
National Provider Identifier
1174813737
Registry record updated Sep 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
Legal business name
PEDIATRIC CARDIOLOGY SERVICES, LLC
Practice address
500 Medical Center Blvd
Suite 390
Lawrenceville, GA 30046-8708
Phone
(770) 995-6684
Fax
(770) 995-7631
NPI assigned
Apr 15, 2011
Last updated
Sep 12, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2012

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

Authorized official

Name
Neill Videlefsky, MD
Title
Ceo
Phone
(770) 995-6684

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0202X GA Primary

Addresses

Primary practice location

500 Medical Center Blvd
Suite 390
Lawrenceville, GA 30046-8708

Mailing address

500 Medical Center Blvd
Suite 390
Lawrenceville, GA 30046-8708
Phone (770) 995-6684

Other identifiers 2

IdentifierTypeStateIssuer
000740891AMedicaidGA
000326873GMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Cardiology Services LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

500 Medical Center Blvd
Ste 390
Lawrenceville, GA 30046
Phone (470) 325-1800

NPI Registry JSON

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

{
    "created_epoch": "1302825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347408000000",
    "number": "1174813737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 MEDICAL CENTER BLVD",
            "address_2": "SUITE 390",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468708",
            "telephone_number": "770-995-6684",
            "fax_number": "770-995-7631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 MEDICAL CENTER BLVD",
            "address_2": "SUITE 390",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468708",
            "telephone_number": "770-995-6684",
            "fax_number": "770-995-7631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CARDIOLOGY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-15",
        "last_updated": "2012-09-12",
        "status": "A",
        "authorized_official_last_name": "VIDELEFSKY",
        "authorized_official_first_name": "NEILL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-995-6684",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000740891A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000326873G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; 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.