Provider Demographics
NPI:1215054754
Name:PUTNAM COUNTY PEDIATRICS
Entity type:Organization
Organization Name:PUTNAM COUNTY PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLIMACO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-526-6173
Mailing Address - Street 1:758 S WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3840
Mailing Address - Country:US
Mailing Address - Phone:931-526-6173
Mailing Address - Fax:931-526-5084
Practice Address - Street 1:758 S WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3840
Practice Address - Country:US
Practice Address - Phone:931-526-6173
Practice Address - Fax:931-526-5084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty