The Pediatric Center, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

200300029 Issued in NC

Legal business name

THE PEDIATRIC CENTER, PLLC

Practice address

1914 Glen Meade Rd
Wilmington, NC 28403-6025

Phone

(910) 762-2651

Fax

(910) 763-5709

NPI assigned

Mar 17, 2006

Last updated

Jul 25, 2011By 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

Dr. Patrick S Edwards, MDNPI 1225004575

Title

Co-Owner

Phone

(910) 762-2651

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Pediatric Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• The Pediatric Center

  • Primary Care Clinic/Center
  • Wilmington, NC
  • NPI 1659485415
  NPD tax ID

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Patrick Scott Edwards, MD

  • Pediatrics Physician
  • Wilmington, NC
  • NPI 1225004575
  NPD (past) Authorized official
• Brittany T Bradshaw, PNP

  • Pediatric Nurse Practitioner
  • Wilmington, NC
  • NPI 1295487585
  NPD (past)
• Jessica Arin Groot, MD

  • Pediatrics Physician
  • Wilmington, NC
  • NPI 1891287942
  NPD (past)
• Eric Michael Jackson, M.D.

  • Pediatrics Physician
  • Wilmington, NC
  • NPI 1346336443
  NPD (past)
• Jennifer Fudge Player, MD

  • Pediatrics Physician
  • Wilmington, NC
  • NPI 1194725036
  NPD (past)
• Patrick Joseph Renton, MD

  • Pediatrics Physician
  • Wilmington, NC
  • NPI 1841409877
  NPD (past)

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311552000000",
    "number": "1457320756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1914 GLEN MEADE RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036025",
            "telephone_number": "910-762-2651",
            "fax_number": "910-763-5709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1914 GLEN MEADE RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036025",
            "telephone_number": "910-762-2651",
            "fax_number": "910-763-5709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDIATRIC CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-17",
        "last_updated": "2011-07-25",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "910-762-2651",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "200300029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89133YG",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Mental Health Association in North Carolina, Inc (New Hanover PSR)
• The Mental Health Association in North Carolina, Inc. (Southeastern ACTT)
• The Milky Mermaid, LLC
• The Momentum Collective LLC
• The Pediatric Center
• The Peedee Clinic
• The Soul Focus, Inc
• The Soul Focus, Inc
• The Wilmington Center PLLC
• The Woman's Place LLC

• Specialist in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2011; 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.