The Children'S Clinic

Primary specialty

SpecialistTaxonomy code 174400000X

License

363L00000X Issued in KY

Legal business name

THE CHILDREN'S CLINIC

Practice address

596 Westport Rd
Elizabethtown, KY 42701-2949

Phone

(270) 679-6888

Fax

(270) 769-9199

NPI assigned

Dec 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Pedro Sagmit Baula Jr., M.D.

Title

Physican

Phone

(270) 769-6888

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1518021237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 WOODSBEND RD",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427019502",
            "telephone_number": "270-737-4709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "596 WESTPORT RD",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012949",
            "telephone_number": "270-679-6888",
            "fax_number": "270-769-9199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHILDREN'S CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAULA",
        "authorized_official_first_name": "PEDRO",
        "authorized_official_middle_name": "SAGMIT",
        "authorized_official_title_or_position": "PHYSICAN",
        "authorized_official_telephone_number": "270-769-6888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "KY",
            "license": "363L00000X",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "KY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1110486",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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.