Organization Active NPI

Pediatric Endocrinology & Diabetes Specialists

  • Pediatric Endocrinology Physician
  • Shelby, NC
National Provider Identifier
1356665756
Registry record updated Apr 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X
Legal business name
PEDIATRIC ENDOCRINOLOGY & DIABETES SPECIALISTS
Practice address
709 N Dekalb St
Shelby, NC 28150-3911
Phone
(704) 512-3636
Fax
(704) 334-7956
NPI assigned
Mar 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2012

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

Authorized official

Name
Daniel L Wiens
Title
Senior Vice President
Phone
(704) 355-0648

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Endocrinology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0205X Primary

Addresses

Primary practice location

709 N Dekalb St
Shelby, NC 28150-3911

Mailing address

PO Box 601381
Charlotte, NC 28260-1381
Phone (704) 512-3636

Other identifiers 1

IdentifierTypeStateIssuer
5902857MedicaidNC

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1268611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333411200000",
    "number": "1356665756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601381",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601381",
            "telephone_number": "704-512-3636",
            "fax_number": "704-334-7956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 N DEKALB ST",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503911",
            "telephone_number": "704-512-3636",
            "fax_number": "704-334-7956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ENDOCRINOLOGY & DIABETES SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-15",
        "last_updated": "2012-04-03",
        "status": "A",
        "authorized_official_last_name": "WIENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "704-355-0648"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902857",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 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.