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NPI Code Detail

MEDICARE: CLEVELAND PEDIATRICS,P.C.

MEDICARE: CLEVELAND PEDIATRICS,P.C.
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
1208000000XPediatrics PhysicianMD16047TN

Other Identifiers

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

General Provider Information

NPI Number : 1609046267
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLEVELAND PEDIATRICS,P.C.
Provider Business Mailing Address
First Line : 435 25TH ST NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-3838
Country : US
Telephone Number : 423-479-9733
Fax Number : 423-472-1890
Provider Business Practice Location Address
First Line : 435 25TH ST NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-3838
Country : US
Telephone Number : 423-479-9733
Fax Number : 423-472-1890
Authorized Official
Title or Position : PRACTICE MANAGER
Name : MRS. EVA GAIL OWNBY
Credential : RN, CPMSM
Telephone Number : 423-479-9733
Provider Enumeration Date : 03/10/2008
Last Update Date : 03/10/2008

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1366614018 — JESSICA L CLIFFORD M.D.
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1326427709 — KATRINA STEWART MD
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Directions to “CLEVELAND PEDIATRICS,P.C. ” Practice Location

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