Provider Demographics
NPI:1639164833
Name:PEDIATRIC GROUP SPECIALISTS, LTD.
Entity type:Organization
Organization Name:PEDIATRIC GROUP SPECIALISTS, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-866-0550
Mailing Address - Street 1:15650 N BLACK CANYON HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4064
Mailing Address - Country:US
Mailing Address - Phone:602-866-0550
Mailing Address - Fax:602-564-2663
Practice Address - Street 1:15650 N BLACK CANYON HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4064
Practice Address - Country:US
Practice Address - Phone:602-866-0550
Practice Address - Fax:602-993-5788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ133545Medicare PIN