Provider Demographics
NPI:1386932051
Name:PEDIATRIC ACQUISITION, INC
Entity type:Organization
Organization Name:PEDIATRIC ACQUISITION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANEANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-207-1085
Mailing Address - Street 1:1221 S TRIMBLE RD
Mailing Address - Street 2:B2
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1522 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3533
Practice Address - Country:US
Practice Address - Phone:419-207-1085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC ACQUISITION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty