The Children's Clinic of Woodville , PLLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

THE CHILDREN'S CLINIC OF WOODVILLE , PLLC

Practice address

900 W Bluff St.
Woodville, TX 75979

Phone

(409) 283-2090

Fax

(409) 283-2097

NPI assigned

Mar 11, 2008

Last updated

May 5, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeffery L Glass, MD

Title

Managing Provider

Phone

(936) 634-2214

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620172800000",
    "number": "1629248125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 150638",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "75915",
            "telephone_number": "936-634-2214",
            "fax_number": "936-634-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W BLUFF ST.",
            "city": "WOODVILLE",
            "state": "TX",
            "postal_code": "75979",
            "telephone_number": "409-283-2090",
            "fax_number": "409-283-2097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHILDREN'S CLINIC OF WOODVILLE , PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A",
        "authorized_official_last_name": "GLASS",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGING PROVIDER",
        "authorized_official_telephone_number": "936-634-2214",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Woodville, TX
• Providers in Woodville, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.