NPIMap

Organization Active NPI

C. Edwin Childers, Jr., MD, PLLC

  • Pediatrics Physician
  • South Charleston, WV
National Provider Identifier
1841408978
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
18115 Issued in WV
Legal business name
C. EDWIN CHILDERS, JR., MD, PLLC
Practice address
4607 Maccorkle Ave SW
MP Ste 204
South Charleston, WV 25309-1364
Phone
(304) 767-7930
Fax
(304) 767-7935
NPI assigned
May 21, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Clark Edwin Childers Jr., M.D.NPI 1184793150
Title
Physician
Phone
(304) 767-7930

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 18115 WV Primary

Addresses

Primary practice location

4607 Maccorkle Ave SW
MP Ste 204
South Charleston, WV 25309-1364

Mailing address

4607 Maccorkle Ave SW
MP Ste 204
South Charleston, WV 25309-1364
Phone (304) 767-7930

Other identifiers 1

IdentifierTypeStateIssuer
0109655000MedicaidWV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841408978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4607 MACCORKLE AVE SW",
            "address_2": "MP STE 204",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091364",
            "telephone_number": "304-767-7930",
            "fax_number": "304-767-7935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4607 MACCORKLE AVE SW",
            "address_2": "MP STE 204",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091364",
            "telephone_number": "304-767-7930",
            "fax_number": "304-767-7935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C. EDWIN CHILDERS, JR., MD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHILDERS",
        "authorized_official_first_name": "CLARK",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "304-767-7930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WV",
            "license": "18115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0109655000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.