NPIMap

Organization Active NPI

Yuma Pediatrics

  • Pediatrics Physician
  • Yuma, AZ
National Provider Identifier
1871653550
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
AZ22611 Issued in AZ
Legal business name
YUMA PEDIATRICS
Practice address
2359 22ND Drive
Suite 2
Yuma, AZ 85364
Phone
(928) 344-4800
Fax
(928) 726-2377
NPI assigned
Dec 11, 2006
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
Mrs. Brenda Faye Tudor
Title
Office Manager
Phone
(928) 344-4800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X AZ22611 AZ Primary

Addresses

Primary practice location

2359 22ND Drive
Suite 2
Yuma, AZ 85364

Mailing address

2359 22ND Drive
Suite 2
Yuma, AZ 85364
Phone (928) 344-4800

Other identifiers 2

IdentifierTypeStateIssuer
186082 02MedicaidAZ
AZ0715400OtherAZBCBC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871653550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2359 22ND DRIVE",
            "address_2": "SUITE 2",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "85364",
            "telephone_number": "928-344-4800",
            "fax_number": "928-726-2377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2359 22ND DRIVE",
            "address_2": "SUITE 2",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "85364",
            "telephone_number": "928-344-4800",
            "fax_number": "928-726-2377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YUMA PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TUDOR",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "FAYE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "928-344-4800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "AZ22611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "186082 02",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBC",
            "identifier": "AZ0715400",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yuma, AZ

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.