MEDICARE: BLUE SPRIG PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1285311266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE SPRIG PEDIATRICS

Provider Business Mailing Address
First Line	:	1737 E CORTEZ DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-4962
Country	:	US
Telephone Number	:	480-432-0093
Fax Number	:

Provider Business Practice Location Address
First Line	:	1737 E CORTEZ DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-4962
Country	:	US
Telephone Number	:	480-432-0093
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIORAL TECHNICIAN
Name	:	KATELYN Z SIMS
Credential	:
Telephone Number	:	480-432-0093

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	06/30/2023

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