Provider Demographics
NPI:1629394614
Name:KIDZCARE PEDIATRICS, PC
Entity Type:Organization
Organization Name:KIDZCARE PEDIATRICS, PC
Other - Org Name:PEDIATRIC ASSOCIATES, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALS MANAGER
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:910-483-7337
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 1:1022 N BRAGG BOULEVARD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-2709
Practice Address - Country:US
Practice Address - Phone:910-495-7337
Practice Address - Fax:910-495-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914484Medicaid
NC016VROtherBCBS NC
NC016VPOtherBCBS NC
NC1342HOtherBLUE CROSS BLUE SHEILD