Provider Demographics
NPI:1124011077
Name:STERNS PEDIATRIC CLINIC,LTD.
Entity Type:Organization
Organization Name:STERNS PEDIATRIC CLINIC,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:SHEINKOPF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-934-0245
Mailing Address - Street 1:5406 W GLENN DR
Mailing Address - Street 2:SUITE #6
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-2662
Mailing Address - Country:US
Mailing Address - Phone:623-934-0245
Mailing Address - Fax:623-934-0428
Practice Address - Street 1:5406 W GLENN DR
Practice Address - Street 2:SUITE #6
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2662
Practice Address - Country:US
Practice Address - Phone:623-934-0245
Practice Address - Fax:623-934-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ272740Medicaid