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General NPI Number Information
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NPI Number | 1114955309
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SERVICES OF AMERICA, LLC
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 110 HORIZON DR STE 100
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City | RALEIGH
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State | NC
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Zip | 27615-4927
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Country | US
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Telephone | 919-481-6712
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Fax | 919-481-9883
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Provider Business Mailing Address
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Address Line | 400 INTERSTATE NORTH PKWY SE STE 1600
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City | ATLANTA
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State | GA
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Zip | 30339-5047
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Country | US
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Telephone | 470-464-8000
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Fax | 770-248-8192
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Authorized Official
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Title or Position | CFO
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Name | MATTHEW BUCKHALTER
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Credential |
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Telephone | 470-464-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | HC0828
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License Number State | NC
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