Organization
BETHESDA PEDIATRICS OF QUEEN CREEK
Active
Other names
PEDIATRICS OF QUEEN CREEK, Main Street Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
STACIE SELF (BILLING)
(480) 792-9200
Entity
Organization
Contact information
Practice address
130 S 63RD ST, MESA, AZ 85206-1620
(480) 792-9200
Mailing address
22707 S ELLSWORTH RD STE H101, QUEEN CREEK, AZ 85142-7568
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
538751
—
AZ
Enumeration date
01/14/2021
Last updated
01/20/2021
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