Provider Demographics
NPI:1154163038
Name:A KIDZ CLINIC
Entity type:Organization
Organization Name:A KIDZ CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCKTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-874-2753
Mailing Address - Street 1:360 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-2379
Mailing Address - Country:US
Mailing Address - Phone:970-874-2753
Mailing Address - Fax:970-874-2943
Practice Address - Street 1:465 LORAH LN
Practice Address - Street 2:
Practice Address - City:HOTCHKISS
Practice Address - State:CO
Practice Address - Zip Code:81419-9301
Practice Address - Country:US
Practice Address - Phone:970-874-2753
Practice Address - Fax:970-874-2943
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A KIDZ CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty