Maysville Internal Medicine Pediatric Assoc PSC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

24430 Issued in KY

Legal business name

MAYSVILLE INTERNAL MEDICINE PEDIATRIC ASSOC PSC

Practice address

2009 Old Main St
Maysville, KY 41056

Phone

(606) 759-7615

Fax

(606) 759-7821

NPI assigned

Oct 24, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Mark Allen Wallingford, MD

Title

President

Phone

(606) 759-7615

Specialties & licenses 3

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465430400000",
    "number": "1841373412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2009 OLD MAIN ST",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "41056",
            "telephone_number": "606-759-7615",
            "fax_number": "606-759-7821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2009 OLD MAIN ST",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "41056",
            "telephone_number": "606-759-7615",
            "fax_number": "606-759-7821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYSVILLE INTERNAL MEDICINE PEDIATRIC ASSOC PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2016-06-09",
        "status": "A",
        "authorized_official_last_name": "WALLINGFORD",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-759-7615",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "24430",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65933012",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR WALLINGFORDS UPIN",
            "identifier": "C78288",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100379280",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Maysville, KY
• Providers in Maysville, KY by specialty
• Internal Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2016; 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.