Provider Demographics
NPI:1487857033
Name:CCPARTNERS LLC
Entity Type:Organization
Organization Name:CCPARTNERS LLC
Other - Org Name:KIDZ BIZ PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-933-4141
Mailing Address - Street 1:35 GOODWIN DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4122
Mailing Address - Country:US
Mailing Address - Phone:636-933-4141
Mailing Address - Fax:636-931-7007
Practice Address - Street 1:35 GOODWIN DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4122
Practice Address - Country:US
Practice Address - Phone:636-933-4141
Practice Address - Fax:636-931-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO100301OtherGROUP HEALTH PLAN
MO507593903Medicaid
MO36393OtherHEALTHCARE USA
MO0191OtherMERCY CARE PLUS