# ABC PEDIATRICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841452000
- **Authorized official:** MRS. RADONA KAY BORGIALLI (OFFICE MANAGER)
- **Authorized official phone:** (307) 686-4900

## Contact information

- **Practice address:** 1300 W 4TH ST, GILLETTE, WY 82716-3339
- **Practice address phone:** (307) 686-4900
- **Practice address fax:** (307) 682-3466
- **Mailing address:** 1300 W 4TH ST, GILLETTE, WY 82716-3339
- **Mailing address phone:** (307) 686-4900
- **Mailing address fax:** (307) 682-3466

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 5966A | WY | Yes |

## Other

- **Enumeration date:** 06/30/2008
- **Last updated:** 06/30/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 121687200 | — | WY |