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CHILDRENS MEDICAL CENTER OF BULLHEAD CITY PLLC NPI 1063510279


NPI Information

NPI: 1063510279
Provider Name: CHILDRENS MEDICAL CENTER OF BULLHEAD CITY, PLLC

Other Name: PLLC

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 03D1001959

Address:
1225 HANCOCK RD
SUITE # B
BULLHEAD CITY, AZ
ZIP 86442
Phone: (928) 758-0183
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CHILDRENS MEDICAL CENTER OF BULLHEAD CITY, PLLC is a pediatrics in Bullhead City, AZ. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. CHILDRENS MEDICAL CENTER OF BULLHEAD CITY, PLLC NPI is 1063510279. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Pllc.

The provider's business location address is:

1225 HANCOCK RD
SUITE # B
BULLHEAD CITY, AZ
ZIP 86442-948
Phone: (928) 758-0183
Fax: (928) 758-6665

The provider's authorized official is Naila Ashraf Tariq .
The authorized official title is Physician and has the following contact phone number (928) 758-0183.

The CLIA number assigned to this NPI record is 03D1001959 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/20/2006 and was last updated on 11/4/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatrics31594ARIZONAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1H98492MEDICARE UPIN
2788531MEDICAIDARIZONA
3Z 77102MEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.