Provider Demographics
NPI:1710220751
Name:KIDS CARE PEDIATRICS, INC
Entity Type:Organization
Organization Name:KIDS CARE PEDIATRICS, INC
Other - Org Name:KIDS CARE PEDIATRICS, INC, NEW ALEXANDRIA OFFICE (2ND LOCAT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLORENDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-537-2131
Mailing Address - Street 1:8279 STATE ROUTE 22
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW ALEXANDRIA
Mailing Address - State:PA
Mailing Address - Zip Code:15670
Mailing Address - Country:US
Mailing Address - Phone:724-668-5023
Mailing Address - Fax:724-668-5075
Practice Address - Street 1:8279 STATE ROAD 22
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW ALEXANDRIA
Practice Address - State:PA
Practice Address - Zip Code:15670
Practice Address - Country:US
Practice Address - Phone:724-668-5023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDS CARE PEDIATRICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055990L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010913070001Medicaid