Organization
SUBURBAN PEDIATRIC CLINIC, INC
Active
Other names
Suburban Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS F LAYMON (SR. VICE PRESIDENT)
(704) 403-2276
Entity
Organization
Contact information
Practice address
3396 CLOVERLEAF PKWY, KANNAPOLIS, NC 28083-6992
(704) 403-7740
(704) 403-7750
Mailing address
3396 CLOVERLEAF PKWY, KANNAPOLIS, NC 28083-6992
(704) 403-7740
(704) 403-7750
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01491
BCBS GROUP ID
NC
05
—
5906978
—
NC
05
—
6901491
—
NC
01
—
896408
MAMSI
NC
Enumeration date
04/04/2006
Last updated
01/26/2016
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