Provider Demographics
NPI:1518677020
Name:PENCE PEDIATRICS, PC
Entity Type:Organization
Organization Name:PENCE PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:719-852-3742
Mailing Address - Street 1:10 RUPERT STREET
Mailing Address - Street 2:WEST ENTRANCE
Mailing Address - City:MONTE VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81144
Mailing Address - Country:US
Mailing Address - Phone:719-852-3742
Mailing Address - Fax:719-785-5741
Practice Address - Street 1:10 RUPERT STREET
Practice Address - Street 2:WEST ENTRANCE
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144
Practice Address - Country:US
Practice Address - Phone:719-852-3742
Practice Address - Fax:719-785-5741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health