Provider Demographics
NPI:1164573564
Name:PRIMARY PEDIATRICS
Entity Type:Organization
Organization Name:PRIMARY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-371-3232
Mailing Address - Street 1:59 CAVALIER BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-3901
Mailing Address - Country:US
Mailing Address - Phone:859-371-3232
Mailing Address - Fax:859-371-6943
Practice Address - Street 1:59 CAVALIER BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3901
Practice Address - Country:US
Practice Address - Phone:859-371-3232
Practice Address - Fax:859-371-6943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty