Provider Demographics
NPI:1699921932
Name:OHIO PEDIATRICS, INC.
Entity type:Organization
Organization Name:OHIO PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-299-2339
Mailing Address - Street 1:1775 DELCO PARK DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1398
Mailing Address - Country:US
Mailing Address - Phone:937-299-2339
Mailing Address - Fax:
Practice Address - Street 1:7200 POE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45414-2547
Practice Address - Country:US
Practice Address - Phone:937-236-5396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0951788Medicaid
OHOH9289221Medicare PIN