Pediatric Clinic

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

164526 Issued in KY

Legal business name

PEDIATRIC CLINIC

Practice address

3604 Cumberland Ave
Middlesboro, KY 40965-2614

Phone

(606) 248-8282

Fax

(606) 248-0030

NPI assigned

Oct 15, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Houshang Khorram, MD

Title

Doctor

Phone

(606) 248-8282

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350259200000",
    "number": "1649522616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3604 WEST CUMBERLAND AVENUE",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "40965",
            "telephone_number": "606-248-8282",
            "fax_number": "606-248-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3604 CUMBERLAND AVE",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409652614",
            "telephone_number": "606-248-8282",
            "fax_number": "606-248-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-15",
        "last_updated": "2012-10-15",
        "status": "A",
        "authorized_official_last_name": "KHORRAM",
        "authorized_official_first_name": "HOUSHANG",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "606-248-8282",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "164526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005628491",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0095596",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16526",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles I. Okwundu, MD
• Radwa Clarissa Omar, APRN
• Steven W Partin, TCM
• Nitinkumar K Patel, MD
• Amber Craig Peace, DO
• Persuaded Health Care, LLC
• Katie Phillips, BSSW
• Pinnacle of Purpose
• Ouen Pongdee, MD PSC INC
• Makenzie Prater

• Pediatrics Physician in Middlesboro, KY
• Providers in Middlesboro, KY by specialty
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; 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.