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General NPI Number Information
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NPI Number | 1871647818
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Entity Type | Organization
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Legal Business Name | RIVER HILLS PEDIATRICS
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 525 ALEXANDRIA PIKE STE 320
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City | SOUTHGATE
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State | KY
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Zip | 41071
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Country | US
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Telephone | 859-781-1310
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Fax | 859-572-3021
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Provider Business Mailing Address
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Address Line | 525 ALEXANDRIA PIKE STE 320
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City | SOUTHGATE
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State | KY
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Zip | 41071-3243
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Country | US
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Telephone | 859-781-1310
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Fax | 859-572-3021
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES JOHN OTREMBIAK
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Credential | M.D.
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Telephone | 859-781-1310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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