Klamath Pediatric Clinic, PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

KLAMATH PEDIATRIC CLINIC, PC

Practice address

2310 Mountain View Blvd
Klamath Falls, OR 97601-1134

Phone

(541) 883-3591

Fax

(541) 883-2886

NPI assigned

Oct 17, 2006

Last updated

Aug 22, 2020By 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

John Aaron Wilson, MD

Title

President

Phone

(541) 883-3591

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669553988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 MOUNTAIN VIEW BLVD",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011134",
            "telephone_number": "541-883-3591",
            "fax_number": "541-883-2886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 MOUNTAIN VIEW BLVD",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011134",
            "telephone_number": "541-883-3591",
            "fax_number": "541-883-2886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KLAMATH PEDIATRIC CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "AARON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-883-3591",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029207",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Klamath Falls, OR
• Providers in Klamath Falls, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.