Organization
CCPARTNERS LLC
Active
Other names
Kidz Biz Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA PAUL BOLDT MD (PHYSICIAN/PARTNER)
(636) 933-4141
Entity
Organization
Contact information
Practice address
35 GOODWIN DR, FESTUS, MO 63028-4122
(636) 933-4141
(636) 931-7007
Mailing address
35 GOODWIN DR, FESTUS, MO 63028-4122
(636) 933-4141
(636) 931-7007
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0191
MERCY CARE PLUS
MO
01
—
100301
GROUP HEALTH PLAN
MO
01
—
36393
HEALTHCARE USA
MO
05
—
507593903
—
MO
Enumeration date
06/08/2007
Last updated
02/07/2014
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