Provider Demographics
NPI:1477059657
Name:ADVANCED CARE PEDIATRIC CENTRE PLLC
Entity Type:Organization
Organization Name:ADVANCED CARE PEDIATRIC CENTRE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-209-2636
Mailing Address - Street 1:1000 E LEXINGTON AVE STE 31
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1707
Mailing Address - Country:US
Mailing Address - Phone:859-209-2636
Mailing Address - Fax:859-209-2643
Practice Address - Street 1:1000 E LEXINGTON AVE STE 31
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1707
Practice Address - Country:US
Practice Address - Phone:859-209-2636
Practice Address - Fax:859-209-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty