Ideal Pediatric Wellness, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

IDEAL PEDIATRIC WELLNESS, LLC

Practice address

10007 Kennerly Rd Ste C
Saint Louis, MO 63128-2179

Phone

(314) 270-9355

NPI assigned

Dec 6, 2017

Last updated

Dec 6, 2017By 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

Dr. Jospeh Cangas, MD

Title

Member

Phone

(314) 270-9355

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512518400000",
    "number": "1710492228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9788 GERALD DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631281708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10007 KENNERLY RD STE C",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282179",
            "telephone_number": "314-270-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL PEDIATRIC WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-06",
        "last_updated": "2017-12-06",
        "status": "A",
        "authorized_official_last_name": "CANGAS",
        "authorized_official_first_name": "JOSPEH",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "314-270-9355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Idalia Blue's Home Health LLC
• Ideal Home Care LLC
• Ideal Special Services LLC (IDEAL Special Services)
• Henry Charles Ideker, MD
• Renee D Idel, ANP
• Osarenren Idemudia, MD
• Identity Home Health Care LLC

• Pediatrics Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; 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.