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General NPI Number Information
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NPI Number | 1851515597
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Entity Type | Organization
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Legal Business Name | NORTHSIDE PEDIATRIC ASSOCIATES, PC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 4225 VICKERS DR
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City | COLUMBUS
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State | IN
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Zip | 47203-4649
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Country | US
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Telephone | 812-379-9524
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Fax | 812-376-6383
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Provider Business Mailing Address
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Address Line | 4225 VICKERS DR
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City | COLUMBUS
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State | IN
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Zip | 47203-4649
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Country | US
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Telephone | 812-379-9524
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Fax | 812-376-6383
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MELISSA DOWNEY
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Credential |
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Telephone | 812-379-9524
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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 | 01038736
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License Number State | IN
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