Provider Demographics
NPI:1194979559
Name:OLD HARDING PEDIATRIC ASSOCIATES, BELLEVUE OFFICE
Entity type:Organization
Organization Name:OLD HARDING PEDIATRIC ASSOCIATES, BELLEVUE OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-352-2995
Mailing Address - Street 1:7640 HIGHWAY 70 S
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1758
Mailing Address - Country:US
Mailing Address - Phone:615-352-2990
Mailing Address - Fax:615-646-8183
Practice Address - Street 1:7640 HIGHWAY 70 S
Practice Address - Street 2:SUITE 202
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-1758
Practice Address - Country:US
Practice Address - Phone:615-352-2990
Practice Address - Fax:615-646-8183
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLD HARDING PEDIATRIC ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty