Prince Edward Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0101242689 Issued in VA

Legal business name

PRINCE EDWARD PEDIATRICS

Practice address

1715 W 3Rd St
Farmville, VA 23901-2651

Phone

(434) 315-0138

Fax

(434) 392-9748

NPI assigned

Jul 25, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Ibtehal Al-Ani

Title

Phyician

Phone

(434) 315-0138

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1406246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406246400000",
    "number": "1447668199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "city": "RICE",
            "state": "VA",
            "postal_code": "239660097",
            "telephone_number": "434-315-0138",
            "fax_number": "434-392-9748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 W 3RD ST",
            "city": "FARMVILLE",
            "state": "VA",
            "postal_code": "239012651",
            "telephone_number": "434-315-0138",
            "fax_number": "434-392-9748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCE EDWARD PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-25",
        "last_updated": "2014-07-25",
        "status": "A",
        "authorized_official_last_name": "AL-ANI",
        "authorized_official_first_name": "IBTEHAL",
        "authorized_official_title_or_position": "PHYICIAN",
        "authorized_official_telephone_number": "434-315-0138",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101242689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609040658",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenna Pierson
• Tyler Postans, PTA
• Marlo Powell
• Elizabeth Anne Power-Defur, PH.D.
• Prince Edward County Department of Social Services
• Prince Edward Volunteer Rescue Squad, Inc
• David E Pruitt, MD
• Mary Ann Pruitt, NP
• Girish Purohit, MD
• Alicia S. Quinn-Houston, MA CCC SLP

• Pediatrics Physician in Farmville, VA
• Providers in Farmville, VA by specialty
• Pediatrics Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2014; 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.