Provider Demographics
NPI:1952609687
Name:QC KIDZ PEDIATRICS PLLC
Entity type:Organization
Organization Name:QC KIDZ PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:UTOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-340-3923
Mailing Address - Street 1:6801 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4458
Mailing Address - Country:US
Mailing Address - Phone:704-340-3923
Mailing Address - Fax:
Practice Address - Street 1:6801 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-4458
Practice Address - Country:US
Practice Address - Phone:704-340-3923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01936261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902894Medicaid