Provider Demographics
NPI:1154302149
Name:ZUCKER HORSLEY TATEM ALTHOFF PROFESSIONAL CORP
Entity Type:Organization
Organization Name:ZUCKER HORSLEY TATEM ALTHOFF PROFESSIONAL CORP
Other - Org Name:PEDIATRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-329-1375
Mailing Address - Street 1:350 W 6TH ST
Mailing Address - Street 2:STE A-2
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4519
Mailing Address - Country:US
Mailing Address - Phone:775-329-2525
Mailing Address - Fax:775-348-0740
Practice Address - Street 1:350 W 6TH ST
Practice Address - Street 2:STE A-2
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4519
Practice Address - Country:US
Practice Address - Phone:775-329-2525
Practice Address - Fax:775-348-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty