NPIMap

Organization Active NPI

Pediatric Associates of Kingston, LLC

  • Pediatrics Physician
  • Kingston, PA
National Provider Identifier
1831201276
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC ASSOCIATES OF KINGSTON, LLC
Practice address
451 3Rd Ave Ste 1
Kingston, PA 18704-5802
Phone
(570) 288-6543
Fax
(570) 288-7130
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

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

Authorized official

Name
Jr Vought
Title
Practice Manager
Phone
(570) 288-6543

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

451 3Rd Ave Ste 1
Kingston, PA 18704-5802

Mailing address

451 3Rd Ave
Kingston, PA 18704-5802
Phone (570) 288-6543

Other practice location 1

1081 Oak St Ste 1
Pittston, PA 18640-3716
Phone (570) 602-7257

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D1017425Pediatric Associates of Kingston LLC451 3Rd Avenue, Kingston, PA 18704Certificate of waiverApr 7, 2027
39D2138236Pediatric Associates of Kingston in Pittston1081 Oak St, Pittston, PA 18640Certificate of waiverOct 11, 2027

National Provider Directory

National Provider Directory

Locations

451 3rd Ave
#1
Kingston, PA 18704
Phone (570) 288-6543

239 S Mountain Blvd
Ste 600
Mountain Top, PA 18707
Phone (570) 474-5209

239 S Mountain Blvd
Mountain Top, PA 18707
Phone (570) 715-7900

1081 Oak St
#1
Pittston, PA 18640
Phone (570) 602-7257

1081 Oak St
Ste 3
Pittston, PA 18640
Phone (570) 502-3098

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618963200000",
    "number": "1831201276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 3RD AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187045802",
            "telephone_number": "570-288-6543",
            "fax_number": "570-288-7130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 3RD AVE STE 1",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187045802",
            "telephone_number": "570-288-6543",
            "fax_number": "570-288-7130"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1081 Oak St Ste 1",
            "address_purpose": "LOCATION",
            "city": "Pittston",
            "state": "PA",
            "postal_code": "186403716",
            "country_code": "US",
            "telephone_number": "570-602-7257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF KINGSTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A",
        "authorized_official_last_name": "VOUGHT",
        "authorized_official_first_name": "JR",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "570-288-6543"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.