Provider Demographics
NPI:1912110990
Name:PEDIATRIC ASSOCIATES OF MT. CARMEL, INC.
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF MT. CARMEL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHAMBERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-752-3650
Mailing Address - Street 1:4371 FERGUSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245
Mailing Address - Country:US
Mailing Address - Phone:513-752-3650
Mailing Address - Fax:513-752-3387
Practice Address - Street 1:4371 FERGUSON DRIVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245
Practice Address - Country:US
Practice Address - Phone:513-752-3650
Practice Address - Fax:513-752-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care