Greensboro Children's Doctor, PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

27124 Issued in NC

Legal business name

GREENSBORO CHILDREN'S DOCTOR, PA

Practice address

515 College Road
Suite 11
Greensboro, NC 27410-5150

Phone

(336) 852-9630

Fax

(336) 852-9665

NPI assigned

Oct 24, 2005

Last updated

Aug 22, 2020By 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

Dr. Richard Walters Boette, M.D.

Title

President

Phone

(336) 852-9630

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275523003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 COLLEGE ROAD",
            "address_2": "SUITE 11",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274105150",
            "telephone_number": "336-852-9630",
            "fax_number": "336-852-9665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 COLLEGE ROAD",
            "address_2": "SUITE 11",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274105150",
            "telephone_number": "336-852-9630",
            "fax_number": "336-852-9665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENSBORO CHILDREN'S DOCTOR, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOETTE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "WALTERS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-852-9630",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "27124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7902775",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Greensboro BG Opco LLC (Richland Place)
• Greensboro Cardiology Associates PA
• Greensboro Cerebral Palsy Association
• Greensboro Cerebral Palsy Association
• Greensboro Children's Clinic, PA
• Greensboro Chiropractic Inc
• Greensboro College Inc., (Greensboro College Sports Medicine)
• Greensboro Counseling and Consultation, PLLC
• Greensboro Counseling and Testing
• Greensboro Counseling Partners PLLC

• Pediatrics Physician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Pediatrics Physician in North Carolina

• 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.