Healthcare Provider Details

I. General information

NPI: 1871647818
Provider Name (Legal Business Name): RIVER HILLS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ALEXANDRIA PIKE STE 320
SOUTHGATE KY
41071
US

IV. Provider business mailing address

525 ALEXANDRIA PIKE STE 320
SOUTHGATE KY
41071-3243
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-1310
  • Fax: 859-572-3021
Mailing address:
  • Phone: 859-781-1310
  • Fax: 859-572-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES JOHN OTREMBIAK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 859-781-1310