NPIMap

Organization Active NPI

Kids Intervention & Diagnostic Service Center, Inc.

Doing business as KIDS Center

  • Pediatrics Physician
  • Bend, OR
National Provider Identifier
1790838324
Registry record updated Mar 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
KIDS INTERVENTION & DIAGNOSTIC SERVICE CENTER, INC.
Doing business as
KIDS Center
Practice address
1375 NW Kingston Ave
Bend, OR 97701-2242
Phone
(541) 383-5958
Fax
(541) 383-3016
NPI assigned
Jan 18, 2007
Last updated
Mar 19, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2009

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

Authorized official

Name
Beth Myra Patterson
Title
General Manager
Phone
(541) 383-5958

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

1375 NW Kingston Ave
Bend, OR 97701-2242

Mailing address

1375 NW Kingston Ave
Bend, OR 97701-2242
Phone (541) 383-5958

Other identifiers 1

IdentifierTypeStateIssuer
058144MedicaidOR

Other names 1

  • KIDS Center Doing business as

National Provider Directory

National Provider Directory

Locations

1375 NW Kingston Ave
Bend, OR 97703
Phone (541) 383-5958

Practitioners & affiliated clinicians

Practitioners 10

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": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237420800000",
    "number": "1790838324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1375 NW KINGSTON AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977012242",
            "telephone_number": "541-383-5958",
            "fax_number": "541-383-3016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 NW KINGSTON AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977012242",
            "telephone_number": "541-383-5958",
            "fax_number": "541-383-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS INTERVENTION & DIAGNOSTIC SERVICE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2009-03-19",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "MYRA",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "541-383-5958"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058144",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KIDS Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2009; 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.