Provider Demographics
NPI:1417009705
Name:AFTER HOUR PEDIATRICS URGENT CARE CLINIC, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:AFTER HOUR PEDIATRICS URGENT CARE CLINIC, A MEDICAL CORPORATION
Other - Org Name:AFTER HOUR PEDIATRICS URGENT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:STREIFINGER
Authorized Official - Last Name:KNIVETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-579-6581
Mailing Address - Street 1:210 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3915
Practice Address - Country:US
Practice Address - Phone:510-579-6581
Practice Address - Fax:650-579-7851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ61931ZOtherBLUE SHIELD ID