Cardiac Kids, PLLC

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

License

25161 Issued in AZ

Legal business name

CARDIAC KIDS, PLLC

Practice address

1330 N Rim Dr
Suite a
Flagstaff, AZ 86001-3134

Phone

(928) 779-7014

Fax

(928) 779-3493

NPI assigned

Mar 29, 2012

Organization subpart

No

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

Authorized official

Name

Jeffrey P Rockow, MD

Title

Ceo

Phone

(928) 779-7014

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

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

{
    "created_epoch": "1332979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376006400000",
    "number": "1124394556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 N RIM DR",
            "address_2": "SUITE A",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013134",
            "telephone_number": "928-779-7014",
            "fax_number": "928-779-3493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 N RIM DR",
            "address_2": "SUITE A",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013134",
            "telephone_number": "928-779-7014",
            "fax_number": "928-779-3493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDIAC KIDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-29",
        "last_updated": "2013-08-09",
        "status": "A",
        "authorized_official_last_name": "ROCKOW",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-779-7014",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "AZ",
            "license": "25161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "393059",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenna Canterbury, DPT
• Laurel Caplan
• Ann Capulin-Thayer, LPC
• Laura Marie Carbone, O.D.
• Cardiac & Peripheral Vascular Specials of Northern Arizona
• Michelle L Cardon, RN
• Careforward Home Care Az LLC
• Douglas John Carlon, MD
• Benjamin Carlos Jr., PT, DPT
• Emily Elizabeth Carlson

• Pediatric Cardiology Physician in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Pediatric Cardiology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.