Provider Demographics
NPI:1154507747
Name:OXFORD PEDIATRICS AND ADOLESCENTS INC
Entity Type:Organization
Organization Name:OXFORD PEDIATRICS AND ADOLESCENTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUERK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-523-2156
Mailing Address - Street 1:5141 MORNING SUN RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056
Mailing Address - Country:US
Mailing Address - Phone:513-523-2156
Mailing Address - Fax:513-523-2503
Practice Address - Street 1:2449 ROSS MILLVILLE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013
Practice Address - Country:US
Practice Address - Phone:513-523-2156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106405Medicaid