MEDICARE: GOOD NIGHT PEDIATRICS EAST VALLEY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center		NV

General Provider Information

NPI Number	:	1063742120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD NIGHT PEDIATRICS EAST VALLEY PC

Provider Business Mailing Address
First Line	:	7720 N 16TH ST STE 425
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4492
Country	:	US
Telephone Number	:	602-476-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2651 N GREEN VALLEY PKWY STE 101D
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-0266
Country	:	US
Telephone Number	:	702-933-5610
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS OPERATIONS
Name	:	KATHERINE SHICK
Credential	:
Telephone Number	:	602-476-8963

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	09/14/2011

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