Basic Information
| Provider Information | |||||||||
| NPI: | 1679543961 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEDIATRICS IN THE PINES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3401 S WHITE MOUNTAIN ROAD | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285375437 | ||||||||
| FaxNumber: | 9285375857 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 S WHITE MOUNTAIN ROAD | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285375437 | ||||||||
| FaxNumber: | 9285375857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 10/04/2011 | ||||||||
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| AuthorizedOfficialLastName: | BARELA | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | EMPLOYEE | ||||||||
| AuthorizedOfficialTelephone: | 9285376567 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0205X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
No ID Information.