NPIMap

Organization Active NPI

Pediatric Preventative Medical Services

  • Pediatrics Physician
  • Birmingham, AL
National Provider Identifier
1356717631
Registry record updated Aug 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
30125 Issued in AL
Legal business name
PEDIATRIC PREVENTATIVE MEDICAL SERVICES
Practice address
6869 5TH Ave S
Birmingham, AL 35212-1866
Phone
(205) 833-9000
Fax
(205) 838-2073
NPI assigned
Aug 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2015

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

Authorized official

Name
Mary Holden Jones, MD
Title
Medical Director
Phone
(205) 552-8691

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 30125 AL Primary

Addresses

Primary practice location

6869 5TH Ave S
Birmingham, AL 35212-1866

Mailing address

6869 5TH Ave S
Birmingham, AL 35212-1866

Other identifiers 1

IdentifierTypeStateIssuer
156044MedicaidAL

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440028800000",
    "number": "1356717631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6869 5TH AVE S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352121866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6869 5TH AVE S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352121866",
            "telephone_number": "205-833-9000",
            "fax_number": "205-838-2073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PREVENTATIVE MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-20",
        "last_updated": "2015-08-20",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "HOLDEN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "205-552-8691",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "30125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156044",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Birmingham, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2015; 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.