Healthcare Provider Details

I. General information

NPI: 1215054754
Provider Name (Legal Business Name): PUTNAM COUNTY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 S WILLOW AVE
COOKEVILLE TN
38501-3840
US

IV. Provider business mailing address

758 S WILLOW AVE
COOKEVILLE TN
38501-3840
US

V. Phone/Fax

Practice location:
  • Phone: 931-526-6173
  • Fax: 931-526-5084
Mailing address:
  • Phone: 931-526-6173
  • Fax: 931-526-5084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER D CLIMACO
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 931-526-6173