Healthcare Provider Details

I. General information

NPI: 1851515597
Provider Name (Legal Business Name): NORTHSIDE PEDIATRIC ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 VICKERS DR
COLUMBUS IN
47203-4649
US

IV. Provider business mailing address

4225 VICKERS DR
COLUMBUS IN
47203-4649
US

V. Phone/Fax

Practice location:
  • Phone: 812-379-9524
  • Fax: 812-376-6383
Mailing address:
  • Phone: 812-379-9524
  • Fax: 812-376-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01038736
License Number StateIN

VIII. Authorized Official

Name: MELISSA DOWNEY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 812-379-9524