Provider Demographics
NPI:1356512818
Name:KIDS CONNECTION PEDIATRICS
Entity type:Organization
Organization Name:KIDS CONNECTION PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIFFANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-404-2020
Mailing Address - Street 1:3811 E. BELL RD.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:602-404-2020
Mailing Address - Fax:602-404-2268
Practice Address - Street 1:3811 E BELL RD.
Practice Address - Street 2:SUITE 110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032
Practice Address - Country:US
Practice Address - Phone:602-404-2020
Practice Address - Fax:602-404-2268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDS CONNECTION PEDIATRICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-12
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26155174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE92610Medicare UPIN