1730204942 NPI number — COMPREHENSIVE PEDIATRICS INC

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 1730204942 NPI number — COMPREHENSIVE PEDIATRICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE PEDIATRICS INC
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:
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:
1730204942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 CROCKER RD
Provider Second Line Business Mailing Address:
600
Provider Business Mailing Address City Name:
WESTLAKE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44145-6966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-871-5100
Provider Business Mailing Address Fax Number:
440-871-5610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 CROCKER RD
Provider Second Line Business Practice Location Address:
600
Provider Business Practice Location Address City Name:
WESTLAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44145-6966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-871-5100
Provider Business Practice Location Address Fax Number:
440-871-5610
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SEBAUGH
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OPERATIONS VP
Authorized Official Telephone Number:
440-871-5100

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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