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General NPI Number Information
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NPI Number | 1508037847
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Entity Type | Organization
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Legal Business Name | WALDEN PONDS MEDICAL CARE LLC
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 5964 GOLF CLUB LN
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City | HAMILTON
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State | OH
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Zip | 45011-8224
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Country | US
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Telephone | 513-893-1100
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Fax | 513-893-1128
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Provider Business Mailing Address
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Address Line | 5964 GOLF CLUB LN
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City | HAMILTON
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State | OH
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Zip | 45011-8224
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Country | US
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Telephone | 513-893-1100
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Fax | 513-893-1128
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHAWNA M HELTON
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Credential |
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Telephone | 513-893-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35081138A
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35081138A
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License Number State | OH
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