Provider Demographics
NPI:1457320756
Name:THE PEDIATRIC CENTER, PLLC
Entity Type:Organization
Organization Name:THE PEDIATRIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:S
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-762-2651
Mailing Address - Street 1:1914 GLEN MEADE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6025
Mailing Address - Country:US
Mailing Address - Phone:910-762-2651
Mailing Address - Fax:910-763-5709
Practice Address - Street 1:1914 GLEN MEADE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6025
Practice Address - Country:US
Practice Address - Phone:910-762-2651
Practice Address - Fax:910-763-5709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300029174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89133YGMedicaid
NC89133YGMedicaid