Provider Demographics
NPI:1174781397
Name:KIDS DOCS PC
Entity type:Organization
Organization Name:KIDS DOCS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALBINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUJAKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-469-2100
Mailing Address - Street 1:12401 OLIVE BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-469-2100
Mailing Address - Fax:314-469-2981
Practice Address - Street 1:12401 OLIVE BLVD
Practice Address - Street 2:STE 204
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-469-2100
Practice Address - Fax:314-469-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty