Healthcare Provider Details

I. General information

NPI: 1700052016
Provider Name (Legal Business Name): SPRINGDALE PEDIATRICS ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11360 SPRINGFIELD PIKE
CINCINNATI OH
45246-4202
US

IV. Provider business mailing address

11360 SPRINGFIELD PIKE
CINCINNATI OH
45246-4202
US

V. Phone/Fax

Practice location:
  • Phone: 513-771-1613
  • Fax:
Mailing address:
  • Phone: 513-771-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRENDA HANAVAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 513-771-1613