Provider Demographics
NPI:1144502246
Name:GOOD NIGHT PEDIATRICS EAST VALLEY PC
Entity type:Organization
Organization Name:GOOD NIGHT PEDIATRICS EAST VALLEY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-476-8963
Mailing Address - Street 1:7720 N 16TH ST STE 425
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4492
Mailing Address - Country:US
Mailing Address - Phone:602-476-0800
Mailing Address - Fax:602-476-0801
Practice Address - Street 1:3600 N 3RD AVE STE B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3904
Practice Address - Country:US
Practice Address - Phone:602-476-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD NIGHT PEDIATRICS EAST VALLEY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care