Provider Demographics
NPI:1407807647
Name:PEDIATRIC HEALTHCARE, SC
Entity Type:Organization
Organization Name:PEDIATRIC HEALTHCARE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-798-1810
Mailing Address - Street 1:20611 WATERTOWN RD
Mailing Address - Street 2:C
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1871
Mailing Address - Country:US
Mailing Address - Phone:262-798-1810
Mailing Address - Fax:262-798-2614
Practice Address - Street 1:20611 WATERTOWN RD
Practice Address - Street 2:C
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1871
Practice Address - Country:US
Practice Address - Phone:262-798-1810
Practice Address - Fax:262-798-2614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
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
WI=========OtherBC/BS