Provider Demographics
NPI:1851802151
Name:OUR KIDZ DOC PLLC
Entity type:Organization
Organization Name:OUR KIDZ DOC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HESS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:480-220-0900
Mailing Address - Street 1:3341 W SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1418
Mailing Address - Country:US
Mailing Address - Phone:480-220-0900
Mailing Address - Fax:
Practice Address - Street 1:3341 W SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1418
Practice Address - Country:US
Practice Address - Phone:480-220-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24191208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1972572832OtherNPI
AZ19725Medicaid