Provider Demographics
NPI:1760643555
Name:GOOD NIGHT PEDIATRICS EAST VALLEY PC
Entity Type:Organization
Organization Name:GOOD NIGHT PEDIATRICS EAST VALLEY PC
Other - Org Name:GOOD NIGHT PEDIATRICS NORTHWEST VALLEY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-476-8963
Mailing Address - Street 1:1440 E MISSOURI AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2458
Mailing Address - Country:US
Mailing Address - Phone:602-476-0800
Mailing Address - Fax:602-476-0801
Practice Address - Street 1:8801 W UNION HILLS DR
Practice Address - Street 2:BLDG A
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8189
Practice Address - Country:US
Practice Address - Phone:602-476-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD NIGHT PEDIATRICS EAST VALLEY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care