Provider Demographics
NPI:1407840341
Name:PEDIATRICS OF LIMA INC
Entity Type:Organization
Organization Name:PEDIATRICS OF LIMA INC
Other - Org Name:PEDIATRICS OF LIMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:WINERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-222-4045
Mailing Address - Street 1:830 W HIGH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3971
Mailing Address - Country:US
Mailing Address - Phone:419-222-4045
Mailing Address - Fax:419-228-5665
Practice Address - Street 1:830 W HIGH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3971
Practice Address - Country:US
Practice Address - Phone:419-222-4045
Practice Address - Fax:419-228-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
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
OH2103762Medicaid