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General NPI Number Information
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NPI Number | 1902888027
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Entity Type | Organization
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Legal Business Name | GOOD NIGHT PEDIATRICS SOUTH MOUNTAIN PC
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 325 E BASELINE RD
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City | PHOENIX
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State | AZ
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Zip | 85042-6510
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Country | US
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Telephone | 602-824-4228
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Fax | 602-824-4259
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Provider Business Mailing Address
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Address Line | 10320 W MCDOWELL RD #L1238
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City | AVONDALE
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State | AZ
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Zip | 85323-4863
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Country | US
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Telephone | 623-643-9233
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Fax | 623-643-9234
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS DEVELOPMENT
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Name | KATHY SHICK
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Credential |
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Telephone | 623-643-9233
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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 | AZ
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