Provider Demographics
NPI:1568067619
Name:ABC'S PEDIATRICS PLLC
Entity Type:Organization
Organization Name:ABC'S PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:928-474-9399
Mailing Address - Street 1:117 E MAIN ST STE D100
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4644
Mailing Address - Country:US
Mailing Address - Phone:928-474-9399
Mailing Address - Fax:928-474-9831
Practice Address - Street 1:117 E MAIN ST STE D100
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4644
Practice Address - Country:US
Practice Address - Phone:928-474-9399
Practice Address - Fax:928-474-9831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ085306Medicaid