NPIMap

Kidzcare Pediatrics, PC

Organization Active NPI Pediatrics Physician · Wallace, NC

NPI 1972015097 · NPPES record last updated Oct 30, 2017

Key facts

NPI
1972015097
Entity type
Organization (NPI type 2)
Primary specialty
Pediatrics Physician 208000000X
Legal business name
KIDZCARE PEDIATRICS, PC
Practice address
112 Medical Village Dr Ste D
Wallace, NC 28466-1665
Phone
(910) 665-1437
Fax
(910) 665-1315
NPI assigned
Oct 30, 2017
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 27

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

View all 27

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2142887Kidzcare Pediatrics, PC
112 Medical Village Drive, Suite D, Wallace, NC 28466		Certificate of waiverJan 21, 2028

National Provider Directory

Tax ID family
Kidzcare Pediatrics PC (28 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208000000X Yes

Addresses

Primary practice location

112 Medical Village Dr Ste D
Wallace, NC 28466-1665

Mailing address

5617 Ramsey St
Fayetteville, NC 28311-1423
Phone (910) 483-7337

Other providers in Wallace, NC

All providers in Wallace, NC · Pediatrics Physician in North Carolina

Sources for this page

Verify at the official NPI Registry.