Jefferson Park Pediatrics P C
LBN: Jefferson Park Pediatrics P C
Jefferson Park Pediatrics P C is an health care organization with primary practice located at 3919 W Jefferson Blvd Ste 1 , Fort Wayne IN 46804-6811. The organization recently has 4 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is the primary health care specialty.
Jefferson Park Pediatrics P C can be contacted via phone (260) 436-7722, or through Veerula, Giridhar Rao via phone (260) 436-7722.
Contact Information
Primary practice address
3919 W Jefferson Blvd Ste 1
Fort Wayne IN 46804-6811
Phone: (260) 436-7722
Fax: (260) 459-0012
Website:
Authorized official contact:
Name: Veerula, Giridhar Rao Doctor of Medicine (MD)
Phone: (260) 436-7722
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | ||
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | ||
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | ||
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X |
Profile Details
| NPI number | 1629263181 |
|---|---|
| LBN Legal business name | Jefferson Park Pediatrics P C |
| DBA Doing business as | |
| Authorized official | Veerula, Giridhar Rao Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Sep 7th, 2007 |
| Last updated | May 23rd, 2024 - about 6 months ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629263181 | NPPES |
| Indiana | MEDICAID | 200262620 |
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