Pediatric Cardiology Consultants, P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

21716 Issued in TN

Legal business name

PEDIATRIC CARDIOLOGY CONSULTANTS, P.C.

Practice address

6401 Poplar Ave
Ste 402
Memphis, TN 38119-4823

Phone

(901) 682-7774

Fax

(901) 682-6963

NPI assigned

Dec 20, 2007

Last updated

Dec 20, 2007By 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

Mrs. Maggie A Bonicelli

Title

Office Manager

Phone

(901) 682-7774

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1198108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198108800000",
    "number": "1407030851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1236",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382421236",
            "telephone_number": "901-682-7774",
            "fax_number": "901-682-6963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 POPLAR AVE",
            "address_2": "STE 402",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381194823",
            "telephone_number": "901-682-7774",
            "fax_number": "901-682-6963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CARDIOLOGY CONSULTANTS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-20",
        "last_updated": "2007-12-20",
        "status": "A",
        "authorized_official_last_name": "BONICELLI",
        "authorized_official_first_name": "MAGGIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "901-682-7774",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TN",
            "license": "21716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014475",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Memphis, TN
• Providers in Memphis, TN by specialty
• Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; 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.