NPIMap

Organization Active NPI

Kidzcare Pediatrics, PC

  • Pediatrics Physician
  • Charlotte, NC
National Provider Identifier
1568082212
Registry record updated Apr 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
KIDZCARE PEDIATRICS, PC
Practice address
416 McCullough Dr Ste 140
Charlotte, NC 28262-4390
Phone
(704) 717-3383
Fax
(704) 717-3393
NPI assigned
Apr 23, 2020
Last updated
Apr 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2020

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

Authorized official

Name
Shantae Renee Lockhart
Title
Credentialing Admin
Phone
(910) 483-7337

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

416 McCullough Dr Ste 140
Charlotte, NC 28262-4390

Mailing address

PO Box 9219
Fayetteville, NC 28311-9082
Phone (910) 483-7737

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1093271Kidzcare Pediatrics PC416 McCullough Drive Ste 140, Charlotte, NC 28262Certificate of waiverDec 14, 2026

National Provider Directory

National Provider Directory
Tax ID family
Kidzcare Pediatrics PC28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1587600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587945600000",
    "number": "1568082212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9219",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283119082",
            "telephone_number": "910-483-7737",
            "fax_number": "910-483-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 MCCULLOUGH DR STE 140",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624390",
            "telephone_number": "704-717-3383",
            "fax_number": "704-717-3393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDZCARE PEDIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-23",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A",
        "authorized_official_last_name": "LOCKHART",
        "authorized_official_first_name": "SHANTAE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CREDENTIALING ADMIN",
        "authorized_official_telephone_number": "910-483-7337"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.