Provider Demographics
NPI:1962911347
Name:BEND KIDS PEDIATRICS, LLC
Entity type:Organization
Organization Name:BEND KIDS PEDIATRICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:WARTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-213-5045
Mailing Address - Street 1:2748 NW CROSSING DR STE 140
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7179
Mailing Address - Country:US
Mailing Address - Phone:541-213-5045
Mailing Address - Fax:
Practice Address - Street 1:2748 NW CROSSING DR STE 140
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7179
Practice Address - Country:US
Practice Address - Phone:541-213-5045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO150927208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty