Healthcare Provider Details

I. General information

NPI: 1245326289
Provider Name (Legal Business Name): WEST SIDE PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

663 ANDERSON FERRY RD
CINCINNATI OH
45238-4751
US

IV. Provider business mailing address

663 ANDERSON FERRY RD
CINCINNATI OH
45238-4751
US

V. Phone/Fax

Practice location:
  • Phone: 513-922-8200
  • Fax: 513-347-0082
Mailing address:
  • Phone: 513-922-8200
  • Fax: 513-347-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOFFICE LOCATION
License Number State

VIII. Authorized Official

Name: R SCOTT HUNTER
Title or Position: VICE PRESIDENT SECRETARY
Credential: MD
Phone: 513-922-8200