Bristol Street Pediatrics, P.C.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

01037473 Issued in IN

Legal business name

BRISTOL STREET PEDIATRICS, P.C.

Practice address

1627 E Bristol St
Elkhart, IN 46514-3817

Phone

(574) 262-0313

Fax

(574) 262-8163

NPI assigned

Jun 16, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Lynnette M Valentijn, MD

Title

Partner

Phone

(574) 262-0313

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1619972650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1627 E BRISTOL ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465143817",
            "telephone_number": "574-262-0313",
            "fax_number": "574-262-8163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1627 E BRISTOL ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465143817",
            "telephone_number": "574-262-0313",
            "fax_number": "574-262-8163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL STREET PEDIATRICS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-16",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "VALENTIJN",
        "authorized_official_first_name": "LYNNETTE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "574-262-0313",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01037473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sean Patrick Bridges, PHARMD
• Hope Briesacker
• Denise Briggs, PHD, HSPP
• Steven D Bright, LCSW
• Julianna Briseno
• David Roger Britzke, O.D.
• Jaida Brock
• Broderick Chiropractic Center
• Jerald R Broderick, D.C.
• Glen H Brookshire, DO

• All providers in Elkhart, IN
• Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; 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.