NPIMap

Organization Active NPI

Family and Pediatric Clinic

  • Counselor
  • Cocoa Beach, FL
National Provider Identifier
1508269747
Registry record updated Oct 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
IMH11652 Issued in FL
Legal business name
FAMILY AND PEDIATRIC CLINIC
Practice address
3000 N Atlantic Ave
Suite 102
Cocoa Beach, FL 32931-5078
Phone
(321) 784-5367
NPI assigned
Oct 2, 2014
Last updated
Oct 2, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2014

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

Authorized official

Name
Betsy Liston
Title
Office Manager
Phone
(321) 784-5367

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X IMH11652 FL Primary

Addresses

Primary practice location

3000 N Atlantic Ave
Suite 102
Cocoa Beach, FL 32931-5078

Mailing address

3000 N Atlantic Ave
Suite 102
Cocoa Beach, FL 32931-5078

National Provider Directory

National Provider Directory
Tax ID family
Family and Pediatric 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.

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1412208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412208000000",
    "number": "1508269747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 N ATLANTIC AVE",
            "address_2": "SUITE 102",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329315078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 N ATLANTIC AVE",
            "address_2": "SUITE 102",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329315078",
            "telephone_number": "321-784-5367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY AND PEDIATRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-02",
        "last_updated": "2014-10-02",
        "status": "A",
        "authorized_official_last_name": "LISTON",
        "authorized_official_first_name": "BETSY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "321-784-5367"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "FL",
            "license": "IMH11652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cocoa Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.