Provider Demographics
NPI:1184016552
Name:KIDZCARE PEDIATRICS, PC
Entity Type:Organization
Organization Name:KIDZCARE PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANTAE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-483-7337
Mailing Address - Street 1:PO BOX 9219
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9082
Mailing Address - Country:US
Mailing Address - Phone:336-763-9292
Mailing Address - Fax:336-763-9491
Practice Address - Street 1:4095 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8410
Practice Address - Country:US
Practice Address - Phone:336-763-9292
Practice Address - Fax:336-763-9491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty