Williston Pediatrics, Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

WILLISTON PEDIATRICS, INC

Practice address

223 N Main St
Williston, FL 32696-2136

Phone

(352) 529-0477

Fax

(352) 529-0406

NPI assigned

Oct 12, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Andrea M Quinlan

Title

Treasurer

Phone

(352) 529-0477

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Rural health clinic certification: CCN 108939

Legal name

WILLISTON PEDIATRICS, INC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Oct 15, 2001

Last certification

Aug 22, 2019

Ownership / control type

For profit – corporation

Organization structure

CorporationProprietary

Incorporated

Feb 11, 2000 in FL

Enrollment address

223 N Main St
Williston, FL 32696-2136

Tax ID family

Williston Pediatrics Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Williston Pediatrics, Inc

  • Rural Health Clinic/Center
  • Williston, FL
  • NPI 1497421267
  NPD tax ID

Locations

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Williston Pediatrics, Inc

  • Rural Health Clinic/Center
  • Williston, FL
  • NPI 1497421267
  NPPES parent name

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1326137001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 N MAIN ST",
            "city": "WILLISTON",
            "state": "FL",
            "postal_code": "326962136",
            "telephone_number": "352-529-0477",
            "fax_number": "352-529-0406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 N MAIN ST",
            "city": "WILLISTON",
            "state": "FL",
            "postal_code": "326962136",
            "telephone_number": "352-529-0477",
            "fax_number": "352-529-0406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLISTON PEDIATRICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "QUINLAN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "352-529-0477",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660141300",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660141301",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Williams Jr.
• Williston Facility Inc
• Williston Family Practice,PA
• Williston Health Care Center, LLC
• Williston Nursing and Rehab LLC
• Williston Pediatrics, Inc
• Williston Rehabilitation and Nursing Center LLC
• Williston Rural Health and Wellness Clinic LLC

• Rural Health Clinic/Center in Williston, FL
• Providers in Williston, FL by specialty
• Rural Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.