Crestview Pediatrics and Adolescent Center PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME74916 Issued in FL

Legal business name

CRESTVIEW PEDIATRICS AND ADOLESCENT CENTER PA

Practice address

332 Medcrest Drive
Crestview, FL 32536

Phone

(850) 683-5100

Fax

(850) 683-5102

NPI assigned

Dec 27, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Bernadine S Peter

Title

Office MGR

Phone

(850) 683-5100

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891850855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 MEDCREST DRIVE",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "32536",
            "telephone_number": "850-683-5100",
            "fax_number": "850-683-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 MEDCREST DRIVE",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "32536",
            "telephone_number": "850-683-5100",
            "fax_number": "850-683-5102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTVIEW PEDIATRICS AND ADOLESCENT CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETER",
        "authorized_official_first_name": "BERNADINE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFFICE MGR",
        "authorized_official_telephone_number": "850-683-5100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME74916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "94749",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crestview Kids
• Crestview MRI
• Crestview Neurology
• Crestview Open MRI Inc
• Crestview Open MRI Inc
• Crestview Pharmacy, LLC
• Crestview Physical and Aquatic Therapy LLC
• Crestview Physical Therapy Inc
• Crestview Rehabilitation Center, LLC
• Crestview Smiles, PA

• Pediatrics Physician in Crestview, FL
• Providers in Crestview, FL by specialty
• Pediatrics Physician in Florida

• 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.