1124259049 NPI number — PEDIATRIA HEALTHCARE, LLC

Table of content: (NPI 1124259049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124259049 NPI number — PEDIATRIA HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIA HEALTHCARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEDIATRIA HEALTHCARE FOR KIDS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124259049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5185 PEACHTREE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORCROSS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30092-6542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-840-1966
Provider Business Mailing Address Fax Number:
770-840-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
353 MARKLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17111-2762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-480-4698
Provider Business Practice Location Address Fax Number:
717-480-4693
Provider Enumeration Date:
07/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DIGNAN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
VICE PRESIDENT AND GENERAL COUNSEL
Authorized Official Telephone Number:
770-840-1966

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 227800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 227900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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