Provider Demographics
NPI:1093250904
Name:PEDIATRIC HOUSECALL SERVICES PLLC
Entity Type:Organization
Organization Name:PEDIATRIC HOUSECALL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DUMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:704-607-3483
Mailing Address - Street 1:6401 STARGAZE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0802
Mailing Address - Country:US
Mailing Address - Phone:704-607-3483
Mailing Address - Fax:704-464-1818
Practice Address - Street 1:1899 TATE BLVD SE
Practice Address - Street 2:SUITE 2108
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4200
Practice Address - Country:US
Practice Address - Phone:828-327-6500
Practice Address - Fax:828-327-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-01
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200214208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89135HHMedicaid
NC89135HHMedicaid