Icon Pediatrics, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

19089 Issued in TN

Legal business name

ICON PEDIATRICS, LLC

Practice address

1900 Church St
Suite 300
Nashville, TN 37203-2234

Phone

(615) 647-8282

Fax

(615) 647-8283

NPI assigned

Apr 3, 2014

Organization subpart

No

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

Authorized official

Name

Eddie D Hamilton, M.D.

Title

Ceo

Phone

(615) 497-4372

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396483200000",
    "number": "1720406010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 CHURCH ST",
            "address_2": "SUITE 300",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372032234",
            "telephone_number": "615-647-8282",
            "fax_number": "615-647-8283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 CHURCH ST",
            "address_2": "SUITE 300",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372032234",
            "telephone_number": "615-647-8282",
            "fax_number": "615-647-8283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICON PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-03",
        "last_updated": "2014-04-03",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-497-4372",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": "19089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3034011",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Nashville, TN
• Providers in Nashville, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2014; 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.