Provider Demographics
NPI:1083979280
Name:PEDIATRIC CARE FOR KIDS
Entity Type:Organization
Organization Name:PEDIATRIC CARE FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-698-8300
Mailing Address - Street 1:4100 FOREST PARK AVE
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2885
Mailing Address - Country:US
Mailing Address - Phone:636-698-8300
Mailing Address - Fax:
Practice Address - Street 1:4100 FOREST PARK AVE
Practice Address - Street 2:SUITE 101A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2885
Practice Address - Country:US
Practice Address - Phone:636-698-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty