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NPI Code Detail

MEDICARE: PEDIATRIC HOME NURSING SERVICES, INC.

MEDICARE: PEDIATRIC HOME NURSING SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251J00000XNursing Care Agency0577L003NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881622199
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC HOME NURSING SERVICES, INC.
Provider Business Mailing Address
First Line : 400 INTERSTATE NORTH PKWY SE STE 1600
Second Line :
City : ATLANTA
State : GA
Zip : 30339-5047
Country : US
Telephone Number : 470-464-8000
Fax Number : 770-248-8192
Provider Business Practice Location Address
First Line : 2250 WEHRLE DR
Second Line : SUITE 1
City : WILLIAMSVILLE
State : NY
Zip : 14221-7037
Country : US
Telephone Number : 716-276-2123
Fax Number : 716-276-2129
Authorized Official
Title or Position : CFO
Name : MATTHEW BUCKHALTER
Credential :
Telephone Number : 470-464-8000
Provider Enumeration Date : 06/28/2006
Last Update Date : 01/27/2025

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