Provider Demographics
NPI:1992752612
Name:JASPER PEDIATRIC ASSOCIATES PC
Entity type:Organization
Organization Name:JASPER PEDIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KREILEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-482-7918
Mailing Address - Street 1:721 W 13TH ST
Mailing Address - Street 2:STE 321
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546
Mailing Address - Country:US
Mailing Address - Phone:812-482-7918
Mailing Address - Fax:812-634-1644
Practice Address - Street 1:721 W 13TH ST
Practice Address - Street 2:STE 321
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546
Practice Address - Country:US
Practice Address - Phone:812-482-7918
Practice Address - Fax:812-634-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty