1821419508 NPI number — KIDZCARE PEDIATRICS, PC

Table of content: (NPI 1821419508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821419508 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:
Provider Other Organization Name Type Code:
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:
1821419508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2015
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:
5244B N SHARON AMITY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28215-0053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-536-0073
Provider Business Practice Location Address Fax Number:
704-535-5722
Provider Enumeration Date:
12/23/2013

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 , with the licence number:  118386 , 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: 1821419508 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9473694 . This is a "PHCS MULTIPLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1821419508 . This is a "HEALTHSMART" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7578540 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1821419508 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2775124 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4142710 . This is a "CIGNA GREATWEST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 016VR . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1821419508 . This is a "HUMANA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1821419508 . This is a "TRICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1821419508 . This is a "FIRST CAROLINA CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1821419508 . This is a "COVENTRY CAROLINAS, PPO, NATIONAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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