1629394614 NPI number — KIDZCARE PEDIATRICS, PC

Table of content: DR. STEVEN JAY WRUBLE M.D. (NPI 1861613531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629394614 NPI number — KIDZCARE PEDIATRICS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDZCARE PEDIATRICS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEDIATRIC ASSOCIATES, PC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629394614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 647
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPE MILLS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28348-0647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-483-7337
Provider Business Mailing Address Fax Number:
910-483-0648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1022 N BRAGG BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING LAKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28390-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-495-7337
Provider Business Practice Location Address Fax Number:
910-495-0747
Provider Enumeration Date:
04/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CREDENTIALS MANAGER
Authorized Official Telephone Number:
910-483-7337

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5914484 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016VR . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 016VP . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1342H . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".