Provider Demographics
NPI:1215471198
Name:KIDZCARE PEDIATRICS, PLLC
Entity type:Organization
Organization Name:KIDZCARE PEDIATRICS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAJI
Authorized Official - Middle Name:KOTTAPPURA
Authorized Official - Last Name:GOPINATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-745-7500
Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37371-0925
Mailing Address - Country:US
Mailing Address - Phone:423-745-7500
Mailing Address - Fax:423-745-7501
Practice Address - Street 1:4233 HIGHWAY 411
Practice Address - Street 2:SUITE B
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-1571
Practice Address - Country:US
Practice Address - Phone:423-745-7500
Practice Address - Fax:423-745-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health