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SPRINGFIELD MEDICAL LLC NPI 1093019150


NPI Information

NPI: 1093019150
Provider Name: SPRINGFIELD MEDICAL LLC

Doing Business As: SPRINGFIELD PEDIATRICS

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 03D2042356

Address:
36351 N GANTZEL RD STE 127
SAN TAN VALLEY, AZ
ZIP 85140
Phone: (602) 734-5509
Get Directions

SPRINGFIELD MEDICAL LLC is a pediatrics in San Tan Valley, 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. SPRINGFIELD MEDICAL LLC NPI is 1093019150. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Springfield Pediatrics.

The provider's business location address is:

36351 N GANTZEL RD STE 127
SAN TAN VALLEY, AZ
ZIP 85140-329
Phone: (602) 734-5509
Fax: (877) 281-3385

The provider's authorized official is Oladiji G Vaughan .
The authorized official title is Owner and has the following contact phone number (602) 734-5509.

The CLIA number assigned to this NPI record is 03D2042356 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/4/2011 and was last updated on 7/25/2023.


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
1208M00000XHospitalist40162ARIZONANo
2208000000XPediatrics40162ARIZONAYes

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
1358032MEDICAIDARIZONA
2584197MEDICAIDARIZONA

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

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