Provider Demographics
NPI:1578758470
Name:EUREKA PEDIATRICS
Entity Type:Organization
Organization Name:EUREKA PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-587-3000
Mailing Address - Street 1:515 N VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1115
Mailing Address - Country:US
Mailing Address - Phone:636-587-3000
Mailing Address - Fax:636-587-2243
Practice Address - Street 1:515 N VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1115
Practice Address - Country:US
Practice Address - Phone:636-587-3000
Practice Address - Fax:636-587-2243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty