Provider Demographics
NPI:1720180862
Name:OLD SCHOOLHOUSE PEDIATRICS INC
Entity Type:Organization
Organization Name:OLD SCHOOLHOUSE PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-535-0453
Mailing Address - Street 1:3011 W SMOKEY ROW RD
Mailing Address - Street 2:STE. A
Mailing Address - City:BARGERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46106-8803
Mailing Address - Country:US
Mailing Address - Phone:317-535-0453
Mailing Address - Fax:317-535-0467
Practice Address - Street 1:3011 W SMOKEY ROW RD
Practice Address - Street 2:STE. A
Practice Address - City:BARGERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46106-8803
Practice Address - Country:US
Practice Address - Phone:317-535-0453
Practice Address - Fax:317-535-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty