1285043125 NPI number — A KIDZ CLINIC

Table of content: (NPI 1285043125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285043125 NPI number — A KIDZ CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A KIDZ CLINIC
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:
1285043125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/13/2018
NPI Reactivation Date:
09/19/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 E 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELTA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81416-2379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-874-2753
Provider Business Mailing Address Fax Number:
970-874-2943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 E 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELTA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81416-2379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-874-2753
Provider Business Practice Location Address Fax Number:
970-399-7005
Provider Enumeration Date:
08/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DOCKTER
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
970-874-2753

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 89658710 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com