Provider Demographics
NPI:1679617138
Name:COTTONWOOD PEDIATRICS, PLC
Entity Type:Organization
Organization Name:COTTONWOOD PEDIATRICS, PLC
Other - Org Name:COTTONWOOD PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HICKIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-690-5437
Mailing Address - Street 1:9356 E RITA RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-6302
Mailing Address - Country:US
Mailing Address - Phone:520-690-5437
Mailing Address - Fax:520-574-1174
Practice Address - Street 1:9356 E RITA RD
Practice Address - Street 2:SUITE 140
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-6302
Practice Address - Country:US
Practice Address - Phone:520-690-5437
Practice Address - Fax:520-574-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31655261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care