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Contact Information

JEFFERSON PARK PEDIATRICS P C
3919 W JEFFERSON BLVD STE 1
FORT WAYNE, IN46804-6811
 Phone: 260-436-7722
 Fax: 260-459-0012
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Dermatology

207N00000X 07 Physician/Dermatology
 

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Integrative Medicine

202D00000X
 

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for JEFFERSON PARK PEDIATRICS P C

NPI # 1629263181
LBN Legal business name JEFFERSON PARK PEDIATRICS P C
Authorized official GIRIDHAR VEERULA - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 09/07/2007
Last updated 04/23/2025 - More than a year ago
Identifiers
IN Medicaid 200262620
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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