Healthcare Provider Details

I. General information

NPI: 1902952948
Provider Name (Legal Business Name): JEFFERSONVILLE PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 SPARKS AVE SUITE 403
JEFFERSONVILLE IN
47130-3739
US

IV. Provider business mailing address

207 SPARKS AVE SUITE 403
JEFFERSONVILLE IN
47130-3739
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-9141
  • Fax: 812-288-1023
Mailing address:
  • Phone: 812-288-9141
  • Fax: 812-288-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1997080410
License Number StateIN

VIII. Authorized Official

Name: DR. JEB M TEICHMAN
Title or Position: OWNER PARTNER
Credential: MD
Phone: 812-288-9141