South Jackson Pediatrics, P.C.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

SOUTH JACKSON PEDIATRICS, P.C.

Doing business as

Riverside Pediatrics

Practice address

760 W Franklin St
Jackson, MI 49201-2048

Phone

(517) 780-9260

Fax

(517) 780-9263

NPI assigned

May 30, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Sandra Kilian, M.D.

Title

President

Phone

(517) 780-9260

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Riverside Pediatrics Doing business as

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405641600000",
    "number": "1952358327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 W FRANKLIN ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012048",
            "telephone_number": "517-780-9260",
            "fax_number": "517-780-9263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 W FRANKLIN ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012048",
            "telephone_number": "517-780-9260",
            "fax_number": "517-780-9263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH JACKSON PEDIATRICS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-30",
        "last_updated": "2014-07-18",
        "status": "A",
        "authorized_official_last_name": "KILIAN",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "517-780-9260",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "350C81070",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatrics Physician in Jackson, MI
• Providers in Jackson, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2014; 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.