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General NPI Number Information
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NPI Number | 1558492702
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Entity Type | Organization
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Legal Business Name | CHILDREN AND TEENAGERS CLINIC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 2401 S. TUCKER AVE. SUITE 4
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City | PITTSBURG
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State | KS
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Zip | 66762
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Country | US
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Telephone | 620-231-2490
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Fax | 620-231-3920
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Provider Business Mailing Address
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Address Line | 2401 S. TUCKER AVE SUITE 4
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City | PITTSBURG
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State | KS
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Zip | 66762
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Country | US
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Telephone | 620-231-2490
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Fax | 620-231-3920
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Authorized Official
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Title or Position | MANAGER
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Name | AMY DODSON
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Credential |
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Telephone | 620-231-2490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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