Basic Information
| Provider Information | |||||||||
| NPI: | 1689632358 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S ACUTE CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 N BUFFALO DR | ||||||||
| Address2: | STE 290 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891283636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023957095 | ||||||||
| FaxNumber: | 7023953502 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 S CLIFF AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053223439 | ||||||||
| FaxNumber: | 6053223654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 02/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | GIOIA | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7023957095 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0203X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1008070 | 05 | SD | MEDICAID |