Provider Demographics
NPI:1306906946
Name:PEDIATRIC ASSOCIATES OF SPRINGFIELD INC
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF SPRINGFIELD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-328-2320
Mailing Address - Street 1:1640 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2652
Mailing Address - Country:US
Mailing Address - Phone:937-328-2320
Mailing Address - Fax:937-525-4775
Practice Address - Street 1:1640 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2562
Practice Address - Country:US
Practice Address - Phone:937-328-2320
Practice Address - Fax:937-525-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0781597Medicaid