Provider Demographics
NPI:1164936019
Name:BEE WELL PEDIATRICS, LLC
Entity Type:Organization
Organization Name:BEE WELL PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRIVORUCHKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-213-4410
Mailing Address - Street 1:2730 OBSERVATORY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2108
Mailing Address - Country:US
Mailing Address - Phone:513-258-0896
Mailing Address - Fax:
Practice Address - Street 1:2730 OBSERVATORY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-2108
Practice Address - Country:US
Practice Address - Phone:513-258-0896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
OH07905363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty