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General NPI Number Information
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NPI Number | 1396721387
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Entity Type | Organization
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Legal Business Name | CENTRAL PEDIATRICS, P.A.
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9680 TAMARACK RD STE 100
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City | WOODBURY
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State | MN
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Zip | 55125-2623
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Country | US
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Telephone | 651-738-0470
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Fax | 651-731-5031
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Provider Business Mailing Address
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Address Line | 9680 TAMARACK RD STE 100
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City | WOODBURY
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State | MN
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Zip | 55125-2623
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Country | US
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Telephone | 651-738-0470
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Fax | 651-731-5031
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. KIM ALTENDORF
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Credential |
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Telephone | 651-731-5026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | MN
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