Provider Demographics
NPI:1689867517
Name:SANSON PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:SANSON PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SANSON-JARACZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-649-1559
Mailing Address - Street 1:203 S CANDY LN
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4120
Mailing Address - Country:US
Mailing Address - Phone:928-649-1559
Mailing Address - Fax:928-649-1427
Practice Address - Street 1:203 S CANDY LN
Practice Address - Street 2:SUITE 6B
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4120
Practice Address - Country:US
Practice Address - Phone:928-649-1559
Practice Address - Fax:928-649-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30834261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ728454002OtherAPIPA
AZ728454Medicaid