Provider Demographics
NPI:1104538958
Name:KIDS ROADS AND SKIES MEDICAL
Entity type:Organization
Organization Name:KIDS ROADS AND SKIES MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-429-5846
Mailing Address - Street 1:21 COUNTY ROAD A4A
Mailing Address - Street 2:
Mailing Address - City:SAPELLO
Mailing Address - State:NM
Mailing Address - Zip Code:87745-5002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 COUNTY ROAD A4A
Practice Address - Street 2:
Practice Address - City:SAPELLO
Practice Address - State:NM
Practice Address - Zip Code:87745-5002
Practice Address - Country:US
Practice Address - Phone:505-429-5846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty