NPIMap

Organization Active NPI

Pediatric Assoc of Petersburg

Doing business as Infant Jesus Childrens Clinic

  • Pediatrics Physician
  • Chester, VA
National Provider Identifier
1457571754
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
0101026123 Issued in VA
Legal business name
PEDIATRIC ASSOC OF PETERSBURG
Doing business as
Infant Jesus Childrens Clinic
Practice address
13213 Rivers Bend Blvd
Chester, VA 23836-8606
Phone
(804) 530-7413
Fax
(804) 530-7411
NPI assigned
Apr 27, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Patricia D Gonzales, MD
Title
Medical Director
Phone
(804) 530-7413

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 0101026123 VA Primary

Addresses

Primary practice location

13213 Rivers Bend Blvd
Chester, VA 23836-8606

Mailing address

13213 Rivers Bend Blvd
Chester, VA 23836-8606
Phone (804) 530-7413

Other names 1

  • Infant Jesus Childrens Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Infant Jesus Children's Clinic2 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.

Locations

13213 Rivers Bend Blvd
Chester, VA 23836
Phone (804) 530-7413

NPI Registry JSON

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

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457571754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13213 RIVERS BEND BLVD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238368606",
            "telephone_number": "804-530-7413",
            "fax_number": "804-530-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13213 RIVERS BEND BLVD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238368606",
            "telephone_number": "804-530-7413",
            "fax_number": "804-530-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOC OF PETERSBURG",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "804-530-7413",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101026123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Infant Jesus Childrens Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chester, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.