Provider Demographics
NPI:1891297925
Name:PEDIATRIC CENTER HOLDINGS, LLC
Entity Type:Organization
Organization Name:PEDIATRIC CENTER HOLDINGS, LLC
Other - Org Name:HUMMINGBIRD EAR TUBE CLINIC FOR KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-718-0092
Mailing Address - Street 1:1158 SUNRISE ALCOVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9284
Mailing Address - Country:US
Mailing Address - Phone:612-718-0092
Mailing Address - Fax:
Practice Address - Street 1:15450 HIGHWAY 7 STE 200
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3522
Practice Address - Country:US
Practice Address - Phone:763-581-8960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical