Athens Pediatrics PLLC
Organization Active NPI Pediatrics Physician · Athens, TN
NPI 1437397809 · NPPES record last updated Jan 23, 2009
Key facts
- NPI
- 1437397809
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- MD32738 (TN)
- Legal business name
- ATHENS PEDIATRICS PLLC
- Practice address
- 111 Epperson St
Athens, TN 37303-3478 - Phone
- (423) 745-5955
- Fax
- (423) 745-6423
- NPI assigned
- Jan 23, 2009
- Organization subpart
- No
Authorized official
- Name
- Cindy Ackaouy
- Title
- Office Manager
- Phone
- (423) 745-5955
Corporate family (same tax ID) 1
Practitioners 1
-
Belen Garcia-Rivas, LMFT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Rural health clinic certification: CCN 448925
- Legal name
- ATHENS PEDIATRICS PLLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 29, 2013
- Last certification
- May 20, 2019
- Ownership / control type
- 1C
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 1, 2009 in TN
- Enrollment address
- 111 Epperson St
Athens, TN 37303-3478
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Melanie K Long |
5% Or Greater Direct Ownership Interest | Feb 10, 2018 | 99% |
| W-2 Managing Employee | May 1, 2013 | 100% | |
| Kathryn J Klopfenstein |
Limited Partnership Interest |
Feb 10, 2018 | 1% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130919000354 | TN | Part a Provider - Rural Health Clinic | 5496999195 | Practice locations: Athens, TN |
National Provider Directory
- Tax ID family
- Athens Pediatrics PLLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | MD32738 | TN | Yes |
Addresses
Primary practice location
111 Epperson St
Athens, TN 37303-3478
Mailing address
111 Epperson St
Athens, TN 37303-3478
Phone (423) 745-5955
Other providers in Athens, TN
- Athens Bone-Joint and Spinal Clinic, PLLC
- Athens City Board of Education
- Athens Clinic of Chiropractic Inc.
- Athens Family Dental
- Athens Pediatrics P.C.
- Athens Pediatrics PLLC
- Athens Physicians Practice LLC
- Athens Physicians Practice LLC
- Athens Physicians Practice LLC
- Athens Physicians Practice LLC
All providers in Athens, TN · Pediatrics Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.