Provider Demographics
NPI:1689110256
Name:HIP KIDS PEDIATRICS PLLC
Entity Type:Organization
Organization Name:HIP KIDS PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUZEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-684-1562
Mailing Address - Street 1:6909 W RAY RD STE 9
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1526
Mailing Address - Country:US
Mailing Address - Phone:480-447-9490
Mailing Address - Fax:
Practice Address - Street 1:6909 W RAY RD STE 9
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1526
Practice Address - Country:US
Practice Address - Phone:480-447-9490
Practice Address - Fax:480-800-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ866105001Medicaid
AZ738773Medicaid