Provider Demographics
NPI:1154195428
Name:ACCESS PEDIATRIC
Entity type:Organization
Organization Name:ACCESS PEDIATRIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PEDDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-652-4060
Mailing Address - Street 1:747 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6279
Mailing Address - Country:US
Mailing Address - Phone:904-290-1462
Mailing Address - Fax:
Practice Address - Street 1:747 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6279
Practice Address - Country:US
Practice Address - Phone:904-290-1462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty