Provider Demographics
NPI:1619104734
Name:PEDIATRIA HEALTHCARE, LLC
Entity Type:Organization
Organization Name:PEDIATRIA HEALTHCARE, LLC
Other - Org Name:PEDIATRIA HEALTHCARE FOR KIKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIGNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-840-1966
Mailing Address - Street 1:53 GRAVEL ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18705-3738
Mailing Address - Country:US
Mailing Address - Phone:570-371-5600
Mailing Address - Fax:570-371-5606
Practice Address - Street 1:53 GRAVEL ST
Practice Address - Street 2:SUITE C
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18705-3738
Practice Address - Country:US
Practice Address - Phone:570-371-5600
Practice Address - Fax:570-371-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2278P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedNeonatal/PediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty