Provider Demographics
NPI:1255481412
Name:PEDIATRIC ASSOCIATES OF MONTGOMERY LTD
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF MONTGOMERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:IRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-984-2510
Mailing Address - Street 1:10600 MONTGOMERY ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242
Mailing Address - Country:US
Mailing Address - Phone:513-984-2510
Mailing Address - Fax:513-984-1015
Practice Address - Street 1:10600 MONTGOMERY ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-984-2510
Practice Address - Fax:513-984-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty