Provider Demographics
NPI:1821419508
Name:KIDZCARE PEDIATRICS, PC
Entity Type:Organization
Organization Name:KIDZCARE PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-483-7337
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-0647
Mailing Address - Country:US
Mailing Address - Phone:910-483-7337
Mailing Address - Fax:910-483-0648
Practice Address - Street 1:5244B N SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-0053
Practice Address - Country:US
Practice Address - Phone:704-536-0073
Practice Address - Fax:704-535-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118386208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1821419508Medicaid
NC9473694OtherPHCS MULTIPLAN
NC1821419508OtherHEALTHSMART
NC7578540OtherAETNA
NC1821419508OtherMEDCOST
NC2775124OtherUNITED HEALTHCARE
NC4142710OtherCIGNA GREATWEST
NC016VROtherBCBS OF NC
NC1821419508OtherHUMANA
NC1821419508OtherTRICARE
NC1821419508OtherFIRST CAROLINA CARE
NC1821419508OtherCOVENTRY CAROLINAS, PPO, NATIONAL