Provider Demographics
NPI:1477304483
Name:PEDIATRIC PLACE, LLC
Entity Type:Organization
Organization Name:PEDIATRIC PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-383-1199
Mailing Address - Street 1:210 S 2ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-2172
Mailing Address - Country:US
Mailing Address - Phone:660-885-2394
Mailing Address - Fax:660-383-1650
Practice Address - Street 1:210 S 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-2172
Practice Address - Country:US
Practice Address - Phone:660-885-2394
Practice Address - Fax:660-383-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty