Provider Demographics
NPI:1710308085
Name:OHIO PEDIATRIC CARE ALLIANCE PHYSICIANS, LLC
Entity Type:Organization
Organization Name:OHIO PEDIATRIC CARE ALLIANCE PHYSICIANS, LLC
Other - Org Name:PEDIATRIC ASSOCIATES OF SPRINGFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CHIEF OPERATING OFFIC
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-722-2259
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1640 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2652
Practice Address - Country:US
Practice Address - Phone:937-328-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO PEDIATRIC CARE ALLIANCE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty