Kings Mountain Pediatric Clinic

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

19089 Issued in NC

Legal business name

KINGS MOUNTAIN PEDIATRIC CLINIC

Practice address

108 Edgemont Dr
Kings Mountain, NC 28086-2702

Phone

(704) 739-2521

Fax

(704) 739-4314

NPI assigned

Jan 6, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Martin Wade Stallings, M.D.

Title

Doctor

Phone

(704) 739-2521

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kings Mountain Pediatrics, PA Former legal business name

Locations

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493164800000",
    "number": "1336127570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 EDGEMONT DR",
            "city": "KINGS MOUNTAIN",
            "state": "NC",
            "postal_code": "280862702",
            "telephone_number": "704-739-2521",
            "fax_number": "704-739-4314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 EDGEMONT DR",
            "city": "KINGS MOUNTAIN",
            "state": "NC",
            "postal_code": "280862702",
            "telephone_number": "704-739-2521",
            "fax_number": "704-739-4314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGS MOUNTAIN PEDIATRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-06",
        "last_updated": "2017-04-26",
        "status": "A",
        "authorized_official_last_name": "STALLINGS",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "704-739-2521",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "19089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8979192",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "79192",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kings Mountain Pediatrics, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Sandra Kay Key, LMBT
• Margaret Kidder, CRNA
• Kings Clinic and Urgent Care PLLC
• Kings Mountain Care Center Inc.
• Kings Mountain Memory Care Center
• Kings Mountain Physical Therapy
• Emily Parrish Kinley
• Laurence Michael Kish, MD
• Anita Emefa Kpodo, MD
• Dang Neng Kue

• Pediatrics Physician in Kings Mountain, NC
• Providers in Kings Mountain, 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 Apr 26, 2017; 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.