Provider Demographics
NPI: | 1508275553 |
---|---|
Name: | KIDZCARE PEDIATRICS, PC |
Entity Type: | Organization |
Organization Name: | KIDZCARE PEDIATRICS, PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | BUSINESS DEVELOPMENT |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | REBECCA |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | WRIGHT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 9101-483-7337 |
Mailing Address - Street 1: | PO BOX 647 |
Mailing Address - Street 2: | |
Mailing Address - City: | HOPE MILLS |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28348-0647 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 910-483-7337 |
Mailing Address - Fax: | 910-483-0648 |
Practice Address - Street 1: | 216 E BROAD ST |
Practice Address - Street 2: | |
Practice Address - City: | SAINT PAULS |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28384-1612 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-483-7337 |
Practice Address - Fax: | 910-483-0648 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-08-04 |
Last Update Date: | 2021-08-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty |