PEDIATRIC FOUNDATIONS, PLLC


Address: 2624 Mt Isle Harbor Dr, Charlotte, NC 28214-5413
Phone: 7274200267

PEDIATRIC FOUNDATIONS, PLLC (NPI# 1932762622) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1932762622
Entity Type Organization
Organization Name PEDIATRIC FOUNDATIONS, PLLC
Practice Address 2624 Mt Isle Harbor Dr
Charlotte
NC 28214-5413
Practice Telephone 7274200267
Mailing Telephone 7274200267
Enumeration Date 2019-04-17
Last Update Date 2019-05-28
Authorized Official Name LINNETTE RICHARDS (OPERATIONS MANAGER)
Authorized Official Telephone 7274200267
Authorized Official Credential OTR/L
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 225100000X Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers
N 225X00000X Occupational Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers
N 235Z00000X Speech-Language Pathologist Speech, Language and Hearing Service Providers
Y 261QM1300X Clinic/Center
Specialization: Multi-Specialty
Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
FL 1659420040 05
NC MEDCOST 1659420040 01
NC TRICARE 1659420040 01
NC BCBSNC 18923 01
NC REHAB PROVIDER NETWORK 2084 01
NC OPTUM 006528 01

Office Location

Street Address 2624 MT ISLE HARBOR DR
City CHARLOTTE
State NC
Zip Code 28214-5413

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Taxonomy Information

Taxonomy Code 261QM1300X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Multi-Specialty

Taxonomy Definition

Definition to come...

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Competitor

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City CHARLOTTE
Zip Code 28214

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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