The Pediatric Clinic, P.a.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

THE PEDIATRIC CLINIC, P.A.

Practice address

940 Holly St NE
Orangeburg, SC 29115-4930

Phone

(803) 536-2725

Fax

(803) 534-1441

NPI assigned

Jul 11, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Peggy C. Thomas

Title

Office Manager

Phone

(803) 536-2725

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica Headden, FNP-C

  • Family Nurse Practitioner
  • Orangeburg, SC
  • NPI 1174272082
  NPD (past)

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1811995111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 HOLLY ST NE",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291154930",
            "telephone_number": "803-536-2725",
            "fax_number": "803-534-1441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 HOLLY ST NE",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291154930",
            "telephone_number": "803-536-2725",
            "fax_number": "803-534-1441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDIATRIC CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-11",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "803-536-2725",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0966",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Methodist Oaks
• The Methodist Oaks
• The Oaks Healthcare LLC
• The Orangeburg Adult Daycare,Inc
• The P Building Pharmacy at the Veil
• The Regional Medical Center
• The Regional Medical Center
• The Regional Medical Center
• The Regional Medical Center of Orangeburg and Calhoun Counties
• The Regional Medical Center of Orangeburg and Calhoun Counties

• Pediatrics Physician in Orangeburg, SC
• Providers in Orangeburg, SC by specialty
• Pediatrics Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.