NPIMap

Organization Active NPI

Southwestern Pediatricspllc

  • Family Nurse Practitioner
  • Maricopa, AZ
National Provider Identifier
1093033110
Registry record updated May 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP3529 Issued in AZ
Legal business name
SOUTHWESTERN PEDIATRICSPLLC
Practice address
21300 N John Wayne Pkwy Ste 109
Maricopa, AZ 85139-8964
Phone
(520) 568-9500
Fax
(520) 568-9533
NPI assigned
May 13, 2010
Organization subpart
Yes
Parent organization
SOUTHWESTERN PEDIATRICS PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 13, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kellie Ann Denos
Title
Front Office
Phone
(480) 857-6316

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X AP3529 AZ Primary

Addresses

Primary practice location

21300 N John Wayne Pkwy Ste 109
Maricopa, AZ 85139-8964

Mailing address

21300 N John Wayne Pkwy Ste 109
Maricopa, AZ 85139-8964
Phone (520) 568-9500

National Provider Directory

National Provider Directory
Tax ID family
Southwestern Pediatrics PLLC4 organizations share this tax ID, including this one
Part of
Southwestern Pediatrics PLLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

21300 N John Wayne Pkwy
Ste 109
Maricopa, AZ 85139
Phone (520) 568-9500

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273708800000",
    "number": "1093033110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21300 N JOHN WAYNE PKWY STE 109",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851398964",
            "telephone_number": "520-568-9500",
            "fax_number": "520-568-9533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21300 N JOHN WAYNE PKWY STE 109",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851398964",
            "telephone_number": "520-568-9500",
            "fax_number": "520-568-9533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWESTERN PEDIATRICSPLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHWESTERN PEDIATRICS PLLC",
        "enumeration_date": "2010-05-13",
        "last_updated": "2010-05-13",
        "status": "A",
        "authorized_official_last_name": "DENOS",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "FRONT OFFICE",
        "authorized_official_telephone_number": "480-857-6316"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP3529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maricopa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.