Peninsula Childrens Clinic Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

601481297 Issued in WA

Legal business name

PENINSULA CHILDRENS CLINIC INC

Practice address

902 E Caroline
Port Angeles, WA 98362

Phone

(360) 457-8578

Fax

(360) 457-4841

NPI assigned

Apr 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey Charles Weller, MD

Title

Pediatrician

Phone

(360) 457-8578

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446681600000",
    "number": "1528025293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 E CAROLINE",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "98362",
            "telephone_number": "360-457-8578",
            "fax_number": "360-457-4841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 E CAROLINE",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "98362",
            "telephone_number": "360-457-8578",
            "fax_number": "360-457-4841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA CHILDRENS CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2015-11-05",
        "status": "A",
        "authorized_official_last_name": "WELLER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PEDIATRICIAN",
        "authorized_official_telephone_number": "360-457-8578",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "601481297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS",
            "identifier": "7058894",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Antonia Pedersen
• Heidi Kristine Pedersen, L.M.P.
• Bradley M Pederson, DPM
• Paul E Pederson, M.D.
• Peninsula Behavioral Health
• Peninsula Family Hearing
• Peninsula Foot and Ankle Clinic PLLC
• Peninsula Integrative Chiropractic
• Peninsula Sleep Solutions
• Gwen Pennington

• Clinic/Center in Port Angeles, WA
• Providers in Port Angeles, WA by specialty
• Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; 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.