Active Kids Pediatrics, PC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

A32674 Issued in AZ

Legal business name

ACTIVE KIDS PEDIATRICS, PC

Practice address

15215 S 48TH St
Suite 110
Phoenix, AZ 85044-9142

Phone

(480) 783-8960

Fax

(480) 783-8967

NPI assigned

Aug 13, 2012

Last updated

Aug 13, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Judith Rosch Barnes Clark, M.D.

Title

Pediatrician, Co-Owner

Phone

(480) 783-8960

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344816000000",
    "number": "1629325378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15215 S 48TH ST",
            "address_2": "SUITE 110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850449142",
            "telephone_number": "480-783-8960",
            "fax_number": "480-783-8967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15215 S 48TH ST",
            "address_2": "SUITE 110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850449142",
            "telephone_number": "480-783-8960",
            "fax_number": "480-783-8967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE KIDS PEDIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-13",
        "last_updated": "2012-08-13",
        "status": "A",
        "authorized_official_last_name": "BARNES CLARK",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "ROSCH",
        "authorized_official_title_or_position": "PEDIATRICIAN, CO-OWNER",
        "authorized_official_telephone_number": "480-783-8960",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "AZ",
            "license": "A32674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Action Chiropractic LLC
• Action Home Healthcare LLC
• Activator Health Center
• Active Friendly Care LLC
• Active Health
• Active Life Center, PLC
• Active Lifestyle Chiropractic
• Active Living PT & Wellness LLC
• Active Vital Care LLC
• Activities for Development, Inc.

• Health Service Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Health Service Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; 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.