1518088871 NPI number — PEDIATRIC PRODUCTS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518088871 NPI number — PEDIATRIC PRODUCTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC PRODUCTS, 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:
Provider Other Organization Name Type Code:
6
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:
1518088871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10679 MCSWAIN DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45241-3168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-891-4633
Provider Business Mailing Address Fax Number:
513-891-4654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11650 LANTERN RD.
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
FISHERS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46038-3102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-721-6893
Provider Business Practice Location Address Fax Number:
513-891-4654
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PAULSON
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
513-891-4633

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200503130A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200503130 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com