Carlos M Vides Jr., M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

10766R Issued in LA

Practice address

4405 Highway 190 East Service Rd
Covington, LA 70433-4957

Phone

(985) 893-8505

Fax

(985) 893-0093

NPI assigned

Nov 30, 2006

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pontchartrain Pediatrics LLC

  • Pediatrics Physician
  • Covington, LA
  • NPI 1881727691

  Pediatrics

  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245308311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4405 HIGHWAY 190 EAST SERVICE RD",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704334957",
            "telephone_number": "985-893-8505",
            "fax_number": "985-893-0093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 HIGHWAY 190 EAST SERVICE RD",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704334957",
            "telephone_number": "985-893-8505",
            "fax_number": "985-893-0093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDES",
        "first_name": "CARLOS",
        "middle_name": "M",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "10766R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1493317",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Covington, LA
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.