Provider Demographics
NPI:1205448057
Name:PUZZLE PEDIATRICS LLC
Entity type:Organization
Organization Name:PUZZLE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:CRIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-407-0691
Mailing Address - Street 1:312 N 700 E
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2702
Mailing Address - Country:US
Mailing Address - Phone:208-407-0691
Mailing Address - Fax:
Practice Address - Street 1:230 N HOSPITAL DR STE 3
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4222
Practice Address - Country:US
Practice Address - Phone:208-407-0691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty