Provider Demographics
NPI:1134297757
Name:PREFERRED PEDIATRICS, INCORPORATED
Entity Type:Organization
Organization Name:PREFERRED PEDIATRICS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-888-3501
Mailing Address - Street 1:5500 RIDGE RD
Mailing Address - Street 2:SUITE 237
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2394
Mailing Address - Country:US
Mailing Address - Phone:440-888-3501
Mailing Address - Fax:440-888-3502
Practice Address - Street 1:5500 RIDGE RD
Practice Address - Street 2:SUITE 237
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2394
Practice Address - Country:US
Practice Address - Phone:440-888-3501
Practice Address - Fax:440-888-3502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2005145Medicaid