Provider Demographics
NPI:1508063991
Name:ABC PEDIATRICS LLC
Entity Type:Organization
Organization Name:ABC PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:KAMIL
Authorized Official - Last Name:ABUJABER AMMARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-686-4900
Mailing Address - Street 1:1300 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3339
Mailing Address - Country:US
Mailing Address - Phone:307-686-4900
Mailing Address - Fax:307-682-3466
Practice Address - Street 1:1300 W 4TH ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3339
Practice Address - Country:US
Practice Address - Phone:307-686-4900
Practice Address - Fax:307-682-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5966A261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health