Provider Demographics
NPI:1518782648
Name:KIDZCARE PEDIATRICS, PLLC
Entity type:Organization
Organization Name:KIDZCARE PEDIATRICS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:CARRIE
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-745-7500
Mailing Address - Street 1:119 EPPERSON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3478
Mailing Address - Country:US
Mailing Address - Phone:423-745-7500
Mailing Address - Fax:423-745-7501
Practice Address - Street 1:1115 BLANTON DR
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5050
Practice Address - Country:US
Practice Address - Phone:865-505-1990
Practice Address - Fax:865-505-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health