MEDICARE: INDIANA PEDIATRIC ASSOCIATES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467589796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA PEDIATRIC ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	2255 PHILADELPHIA ST
Second Line	:	STE A AND STE B
City	:	INDIANA
State	:	PA
Zip	:	15701-1595
Country	:	US
Telephone Number	:	724-463-0476
Fax Number	:	742-463-1196

Provider Business Practice Location Address
First Line	:	2255 PHILADELPHIA ST STE A
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-1595
Country	:	US
Telephone Number	:	724-463-0476
Fax Number	:	742-463-1196

Authorized Official
Title or Position	:	OFFICER MANAGER
Name	:	JONNA KELLER
Credential	:	RN
Telephone Number	:	724-463-0476

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	03/09/2026

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