Provider Demographics
NPI:1225258775
Name:PEDIATRIC CARE UNLIMITED, INC.
Entity Type:Organization
Organization Name:PEDIATRIC CARE UNLIMITED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-252-9227
Mailing Address - Street 1:230 GEORGE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2620
Mailing Address - Country:US
Mailing Address - Phone:304-252-9227
Mailing Address - Fax:304-252-0454
Practice Address - Street 1:230 GEORGE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2620
Practice Address - Country:US
Practice Address - Phone:304-252-9227
Practice Address - Fax:304-252-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0207468000Medicaid