Provider Demographics
NPI:1609837038
Name:THE PEDIATRIC HEALTHCARE CENTER LLC
Entity Type:Organization
Organization Name:THE PEDIATRIC HEALTHCARE CENTER LLC
Other - Org Name:THE PEDIATRIC HEALTHCARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-394-2610
Mailing Address - Street 1:1010 HAGER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2421
Mailing Address - Country:US
Mailing Address - Phone:419-394-2610
Mailing Address - Fax:419-394-6605
Practice Address - Street 1:1010 HAGER ST
Practice Address - Street 2:
Practice Address - City:ST MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885
Practice Address - Country:US
Practice Address - Phone:419-394-2610
Practice Address - Fax:419-394-6605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068454208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty