Southfork Pediatrics, PLLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

9701479 Issued in NC

Legal business name

SOUTHFORK PEDIATRICS, PLLC

Practice address

1733 Connelly Springs Rd
Lenoir, NC 28645-7827

Phone

(828) 726-8885

Fax

(828) 726-8883

NPI assigned

Jun 21, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Debra K Brown

Title

Practice Manager

Phone

(828) 726-1379

Specialties & licenses 1

Addresses

Other identifiers 6

Locations

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1992701445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1733 CONNELLY SPRINGS RD",
            "city": "LENOIR",
            "state": "NC",
            "postal_code": "286457827",
            "telephone_number": "828-726-8885",
            "fax_number": "828-726-8883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1733 CONNELLY SPRINGS RD",
            "city": "LENOIR",
            "state": "NC",
            "postal_code": "286457827",
            "telephone_number": "828-726-8885",
            "fax_number": "828-726-8883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHFORK PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "828-726-1379",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NC",
            "license": "9701479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891141R",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "B0324",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "1141R",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2359139",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAROLINA ACCESS",
            "identifier": "891141R",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1467112",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Ann Smith, OTR-L
• Jonathan Rowland Smith
• Osha Smith, LCAS-A
• Sally Rae Soucy, CNM, ARNP
• Southern Assisted Living, LLC.
• James Richard Sowell, MD
• Katherine Spake
• Sandra St Louis Thompson, NURSE PRACTITIONER
• Rodney M Stalheim, M.D.
• James Edward Stanislaw, MD

• Medical Specialty Clinic/Center in Lenoir, NC
• Providers in Lenoir, NC by specialty
• Medical Specialty Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.