Healthcare Provider Details

I. General information

NPI: 1245562826
Provider Name (Legal Business Name): CRAZY ABOUT KIDS PULMONARY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 E BASELINE RD STE 205
GILBERT AZ
85234-2726
US

IV. Provider business mailing address

PO BOX 9362
BELFAST ME
04915-9362
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-2260
  • Fax: 480-892-2274
Mailing address:
  • Phone: 480-892-2260
  • Fax: 480-892-2274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACI ARNEY
Title or Position: MANAGER
Credential: NP
Phone: 480-892-2260