NPIMap

Organization Active NPI

Carlos E Lucero

Doing business as Beckley Neonatal-Pediatric Care

  • Pediatric Adolescent Medicine Physician
  • Beckley, WV
National Provider Identifier
1649304395
Registry record updated Aug 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
10355 Issued in WV
Legal business name
CARLOS E LUCERO
Doing business as
Beckley Neonatal-Pediatric Care
Practice address
403 Carriage Dr
Beckley, WV 25801-2805
Phone
(304) 255-7456
Fax
(304) 255-5899
NPI assigned
Mar 15, 2007
Last updated
Aug 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2008

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

Authorized official

Name
Carlos Estanislao Lucero, MDNPI 1033164645
Title
Owner
Phone
(304) 255-7456

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 10355 WV Primary

Addresses

Primary practice location

403 Carriage Dr
Beckley, WV 25801-2805

Mailing address

403 Carriage Dr
Beckley, WV 25801
Phone (304) 255-7456

Other identifiers 3

IdentifierTypeStateIssuer
0112021000MedicaidWV
3810002253MedicaidWV
3810002253OtherWVMEDICAID GROUP

Other names 1

  • Beckley Neonatal-Pediatric Care Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1649304395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 CARRIAGE DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "25801",
            "telephone_number": "304-255-7456",
            "fax_number": "304-255-5899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 CARRIAGE DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258012805",
            "telephone_number": "304-255-7456",
            "fax_number": "304-255-5899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLOS E LUCERO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "LUCERO",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "ESTANISLAO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-255-7456",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "WV",
            "license": "10355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0112021000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810002253",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP",
            "identifier": "3810002253",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beckley Neonatal-Pediatric Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beckley, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.