1710220751 NPI number — KIDS CARE PEDIATRICS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710220751 NPI number — KIDS CARE PEDIATRICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDS CARE PEDIATRICS, INC
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:
Provider Other Organization Name Type Code:
6
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:
1710220751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8279 STATE ROUTE 22
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
NEW ALEXANDRIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-668-5023
Provider Business Mailing Address Fax Number:
724-668-5075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8279 STATE ROAD 22
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
NEW ALEXANDRIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-668-5023
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
FLORENDO
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-537-2131

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD055990L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1010913070001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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