Provider Demographics
NPI:1013465327
Name:KIDS ARE GREAT PEDIATRICS
Entity Type:Organization
Organization Name:KIDS ARE GREAT PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-577-4200
Mailing Address - Street 1:320 E FONTANERO ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7529
Mailing Address - Country:US
Mailing Address - Phone:719-577-4200
Mailing Address - Fax:719-442-6595
Practice Address - Street 1:320 E FONTANERO ST
Practice Address - Street 2:SUITE 308
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7529
Practice Address - Country:US
Practice Address - Phone:719-577-4200
Practice Address - Fax:719-442-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022379261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66353785Medicaid