MEDICARE: PEDIATRIC HEALTH CENTER INC

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

General Provider Information

NPI Number	:	1649340514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	6363 YORK RD
Second Line	:	SUITE 103
City	:	PARMA HTS
State	:	OH
Zip	:	44130
Country	:	US
Telephone Number	:	440-888-1500
Fax Number	:	440-888-5809

Provider Business Practice Location Address
First Line	:	6363 YORK RD
Second Line	:	SUITE 103
City	:	PARMA HTS
State	:	OH
Zip	:	44130
Country	:	US
Telephone Number	:	440-888-1500
Fax Number	:	440-888-5809

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JOSEPH A JAMHOUR
Credential	:	MD
Telephone Number	:	440-888-1500

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/22/2020

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