Village Pediatrics, PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

K0154 Issued in TX

Legal business name

VILLAGE PEDIATRICS, PA

Practice address

998 Winscott Rd
Benbrook, TX 76126-2744

Phone

(817) 249-4155

Fax

(817) 249-0497

NPI assigned

Jul 2, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Stephanie Perdue, MD

Title

President

Phone

(817) 249-4155

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1942463724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4917 RIVERBEND DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761092436",
            "telephone_number": "817-249-4155",
            "fax_number": "817-249-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "998 WINSCOTT RD",
            "city": "BENBROOK",
            "state": "TX",
            "postal_code": "761262744",
            "telephone_number": "817-249-4155",
            "fax_number": "817-249-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE PEDIATRICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "PERDUE",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-249-4155",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "K0154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1331803-06",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1331803-04",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "K0154",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Catheline Velasquez
• Claudia Angelica Velasquez
• Jessica N Velez
• Eddy R Via, MD
• Sophia Vigilante
• Vista Living of Archer, Inc.
• Vista Living of Vernon, Inc.
• Wal-Mart Stores Texas LLC
• Wal-Mart Stores Texas, LLC
• Walgreen Co

• Pediatrics Physician in Benbrook, TX
• Providers in Benbrook, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; 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.