Provider Demographics
NPI:1154588325
Name:UNION PEDIATRICS, PSC
Entity type:Organization
Organization Name:UNION PEDIATRICS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-384-2550
Mailing Address - Street 1:8667 US HIGHWAY 42 STE 300
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-8759
Mailing Address - Country:US
Mailing Address - Phone:859-384-2550
Mailing Address - Fax:859-384-0947
Practice Address - Street 1:8667 US HIGHWAY 42 STE 300
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-8759
Practice Address - Country:US
Practice Address - Phone:859-384-2550
Practice Address - Fax:859-384-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35665208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64012412Medicaid
KY64012412Medicaid