Provider Demographics
NPI:1427021476
Name:SOUTHPOINTE PEDIATRICS, PC
Entity Type:Organization
Organization Name:SOUTHPOINTE PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-887-3344
Mailing Address - Street 1:8851 SOUTHPOINTE DR
Mailing Address - Street 2:C-2
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-0975
Mailing Address - Country:US
Mailing Address - Phone:317-887-3344
Mailing Address - Fax:317-885-5018
Practice Address - Street 1:8851 SOUTHPOINTE DR
Practice Address - Street 2:C-2
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0975
Practice Address - Country:US
Practice Address - Phone:317-887-3344
Practice Address - Fax:317-885-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003909208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty