MEDICARE: KIDZCARE PEDIATRICS, 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	208000000X	Pediatrics Physician	200101222	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	016VR	OTHER	NC	BCBS NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861627226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDZCARE PEDIATRICS, PC

Provider Business Mailing Address
First Line	:	PO BOX 647
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-0647
Country	:	US
Telephone Number	:	910-483-7337
Fax Number	:	910-483-0648

Provider Business Practice Location Address
First Line	:	5617 RAMSEY STREET
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-1423
Country	:	US
Telephone Number	:	910-423-7337
Fax Number	:	910-480-3029

Authorized Official
Title or Position	:	CREDENTIALS MANAGER
Name	:	MS. REBECCA E WRIGHT
Credential	:
Telephone Number	:	910-483-7337

Provider Enumeration Date	:	05/28/2009
Last Update Date	:	03/25/2016

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