Provider Demographics
NPI:1457023111
Name:PENCE PEDIATRICS, PC
Entity Type:Organization
Organization Name:PENCE PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MIKAILA
Authorized Official - Middle Name:HELDT
Authorized Official - Last Name:PENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-890-7723
Mailing Address - Street 1:PO BOX 4804
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-4804
Mailing Address - Country:US
Mailing Address - Phone:719-890-7723
Mailing Address - Fax:
Practice Address - Street 1:613 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-9551
Practice Address - Country:US
Practice Address - Phone:719-890-7723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health