Healthcare Provider Details

I. General information

NPI: 1144502246
Provider Name (Legal Business Name): GOOD NIGHT PEDIATRICS EAST VALLEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 N 3RD AVE STE B
PHOENIX AZ
85013-3904
US

IV. Provider business mailing address

7720 N 16TH ST STE 425
PHOENIX AZ
85020-4492
US

V. Phone/Fax

Practice location:
  • Phone: 602-476-0800
  • Fax:
Mailing address:
  • Phone: 602-476-0800
  • Fax: 602-476-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: KATHERINE H SHICK
Title or Position: DIRECTOR OF BUSINESS OPERATIONS
Credential:
Phone: 602-476-8963