Provider Demographics
NPI:1609311109
Name:ARIZONA KIDS PEDIATRICS LTD
Entity Type:Organization
Organization Name:ARIZONA KIDS PEDIATRICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER.PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-403-1613
Mailing Address - Street 1:14823 W BELL RD STE 208
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7613
Mailing Address - Country:US
Mailing Address - Phone:623-225-7030
Mailing Address - Fax:
Practice Address - Street 1:14823 W BELL RD STE 208
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7613
Practice Address - Country:US
Practice Address - Phone:623-225-7030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4394261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112727Medicaid