Healthcare Provider Details

I. General information

NPI: 1902091572
Provider Name (Legal Business Name): THE PEDIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 BELLEFONTAINE AVE
LIMA OH
45804-2888
US

IV. Provider business mailing address

967 BELLEFONTAINE AVE
LIMA OH
45804-2888
US

V. Phone/Fax

Practice location:
  • Phone: 419-224-5437
  • Fax: 419-224-8714
Mailing address:
  • Phone: 419-224-5437
  • Fax: 419-224-8714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0819609
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: MRS. VALERIE J KLINE
Title or Position: BILLING MANAGER
Credential:
Phone: 419-224-7056