Basic Information
| Provider Information | |||||||||
| NPI: | 1740429844 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIDS COUNT PEDIATRICS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1919 N BRIDGE ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ELKIN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286212105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368357337 | ||||||||
| FaxNumber: | 3368357301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1919 N BRIDGE ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ELKIN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286212105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368357337 | ||||||||
| FaxNumber: | 3368357301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2009 | ||||||||
| LastUpdateDate: | 10/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | SPARKS | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3368357337 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 200401187 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.