Provider Demographics
NPI:1578762647
Name:PEDIATRIC PLACE OF UNION CITY LLC
Entity Type:Organization
Organization Name:PEDIATRIC PLACE OF UNION CITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-885-4338
Mailing Address - Street 1:1613 STONEHEDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5976
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1117 S MILES AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5439
Practice Address - Country:US
Practice Address - Phone:731-885-4338
Practice Address - Fax:731-885-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42330208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty