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PEDIATRIC ASSOCIATES PROF LLC
NPI 1043016124
Clinic/Center - Rural Health in Delta, CO

Active since February 20, 2025CLIA 06D2021354 · Waiver
242 COTTONWOOD ST, DELTA, CO 81416(970) 874-7552(855) 638-4966 Get Directions Write a Review

NPPES record last updated: February 20, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Pediatric Associates Prof Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PEDIATRIC ASSOCIATES PROF LLC (NPI 1043016124) is a healthcare organization registered as a rural health in Delta, Colorado and active in the NPI registry since February 2025. The organization holds a CLIA Waiver certificate valid through March 10, 2027 and lists Amber Hickert, Practice Administrator, as its authorized official.

NPPES Registry Identity

NPI1043016124
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NamePEDIATRIC ASSOCIATES PROF LLC
Location Address242 COTTONWOOD STDelta, CO 81416-4403
Mailing Address947 South 5th StreetMontrose, CO 81401 · (970) 249-2421 · Fax (855) 638-4966
Phone(970) 874-7552
Fax(855) 638-4966
Organization SubpartYes
Authorized OfficialAmber HickertPractice Administrator · (970) 249-2421
Enumeration DateFebruary 20, 2025
NPPES CertifiedFebruary 20, 2025
✔ NPI 1043016124 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
242 COTTONWOOD ST, Delta, CO 81416
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 06D2021354

Pediatric Associates · Delta, CO
Active · expires Mar 10, 2027
CLIA Number06D2021354
Laboratory TypePhysician Office
Certificate Effective DateMarch 11, 2025
Certificate Expiration DateMarch 10, 2027
Laboratory DirectorDr. Romeo G. Icasiano
Laboratory Phone(970) 874-7552
Laboratory LocationPediatric Associates242 Cottonwood St Ste 101, Delta, CO 81416
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pediatric Associates Prof LLC's NPI number?

The NPI number for Pediatric Associates Prof LLC is 1043016124. It was assigned to this organization in the NPPES registry on February 20, 2025.

Where is Pediatric Associates Prof LLC located?

Pediatric Associates Prof LLC is located at 242 Cottonwood St, Delta, CO 81416. The listed phone number is (970) 874-7552.

What is Pediatric Associates Prof LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

Does Pediatric Associates Prof LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 06D2021354) is associated with this NPI, valid through March 10, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Pediatric Associates Prof LLC was last updated on February 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.