J. Colton Bradshaw, M.D.11/11/1952
Individual provider Active NPI Pediatrics Physician · Mount Pleasant, TX
NPI 1902893019 · NPPES record last updated Jan 17, 2013
Key facts
- NPI
- 1902893019
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- F8808 (TX)
- Practice address
- 2001 N Jefferson Ave
Suite 300
Mount Pleasant, TX 75455-2371 - Phone
- (903) 572-9823
- Fax
- (903) 572-4812
- NPI assigned
- Oct 4, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101101000231 | TX | Practitioner - Pediatric Medicine | 1850585134 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Pediatric Clinic, P.a. | Current |
Accepting new patients | |
| The Pediatric Clinic, P.a. | Pediatrics | Current |
Accepting new patients |
Locations
2001 N Jefferson Ave
Ste 300
Mt Pleasant, TX 75455
Phone (903) 572-9823
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | F8808 | TX | Yes |
Addresses
Primary practice location
2001 N Jefferson Ave
Suite 300
Mount Pleasant, TX 75455-2371
Mailing address
2001 N Jefferson Ave
Suite 300
Mount Pleasant, TX 75455-2371
Phone (903) 572-9823
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 130955102 | Medicaid | TX |
Other providers in Mount Pleasant, TX
- Tammy Lynn Boggs
- John D Boldan Jr.
- Robyn Ann Boles
- James Daniel Bove III
- Jimmy Boyd
- Michael K. Brandon II
- Caitlin Jo Branham
- Susan L Branham
- Bratton Healthcare Clinic, PLLC
- Bratton Healthcare Enterprises PLLC
All providers in Mount Pleasant, TX · Pediatrics Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.