Basic Information
| Provider Information | |||||||||
| NPI: | 1023252061 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KIDS COUNT PEDIATRICS, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KIDS COUNT BEHAVIORAL HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1919 N BRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | ELKIN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286212105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368357337 | ||||||||
| FaxNumber: | 3368357301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1919 N BRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | ELKIN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286212105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368357337 | ||||||||
| FaxNumber: | 3368357301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2009 | ||||||||
| LastUpdateDate: | 04/21/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | THORP | ||||||||
| AuthorizedOfficialFirstName: | LEWIS | ||||||||
| AuthorizedOfficialMiddleName: | SUMNER | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMIN./CONSULTANT | ||||||||
| AuthorizedOfficialTelephone: | 3369723971 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KIDS COUNT PEDIATRICS, PLLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.