NPIMap

Organization Active NPI

Cleveland Health Ventures, LLC

Doing business as Shelby Children's Clinic

  • Pediatrics Physician
  • Shelby, NC
National Provider Identifier
1598830408
Registry record updated Aug 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CLEVELAND HEALTH VENTURES, LLC
Doing business as
Shelby Children's Clinic
Practice address
709 N Dekalb St
Shelby, NC 28150-3911
Phone
(980) 487-2100
Fax
(704) 482-8779
NPI assigned
Nov 24, 2006
Last updated
Aug 6, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
CLEVELAND HEALTH VENTURES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 6, 2013

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

Authorized official

Name
Mr. Daniel L Wiens
Title
Senior Vice President
Phone
(704) 355-0648

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X NU
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

709 N Dekalb St
Shelby, NC 28150-3911

Mailing address

PO Box 601884
Charlotte, NC 28260-1884
Phone (980) 487-2100

Other identifiers 3

IdentifierTypeStateIssuer
5905487MedicaidNC
6006026MedicaidNC
5905769MedicaidNC

Other names 1

  • Shelby Children's Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cleveland Health Ventures10 organizations share this tax ID, including this one
Part of
Cleveland Health Ventures

Other organizations with this tax ID 9

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375747200000",
    "number": "1598830408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601884",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601884",
            "telephone_number": "980-487-2100",
            "fax_number": "704-482-8779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 N DEKALB ST",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503911",
            "telephone_number": "980-487-2100",
            "fax_number": "704-482-8779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEVELAND HEALTH VENTURES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLEVELAND HEALTH VENTURES, LLC",
        "enumeration_date": "2006-11-24",
        "last_updated": "2013-08-06",
        "status": "A",
        "authorized_official_last_name": "WIENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "704-355-0648",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5905487",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006026",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5905769",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shelby Children's Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelby, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; 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.