Provider Demographics
NPI:1801893425
Name:SURPRISE PEDIATRICS
Entity type:Organization
Organization Name:SURPRISE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-876-9983
Mailing Address - Street 1:14239 W BELL RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2469
Mailing Address - Country:US
Mailing Address - Phone:623-876-9983
Mailing Address - Fax:623-876-9984
Practice Address - Street 1:14239 W BELL RD
Practice Address - Street 2:SUITE 112
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2469
Practice Address - Country:US
Practice Address - Phone:623-876-9983
Practice Address - Fax:623-876-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28681173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty