Organization
KIDZCARE PEDIATRICS, PC
Active
Other names
Pediatric Associates, PC
Organization subpart
No
Provider details
NPI number
Authorized official
SHANTAE RENEE LOCKHART (CREDENTIALS SPECIALIST)
(910) 483-7337
Entity
Organization
Contact information
Practice address
3436 N MAIN STREET, HOPE MILLS, NC 28348
(910) 426-7337
(910) 424-1418
Mailing address
PO BOX 9219, FAYETTEVILLE, NC 28311-9082
(910) 483-7337
(910) 483-0648
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016VP
BCBS GROUP# FOR NORTHSIDE
NC
01
—
016VR
BCBS GROUP# HOPEMILLS
NC
05
—
5900115
—
NC
05
—
5900116
—
NC
05
—
5900116,5908525
—
NC
05
—
5950741,5914484
—
NC
Enumeration date
05/26/2006
Last updated
05/15/2018
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