Provider Demographics
NPI:1720191877
Name:PEDIATRICS AFTER HOURS, LLC
Entity Type:Organization
Organization Name:PEDIATRICS AFTER HOURS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRON-SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-938-0920
Mailing Address - Street 1:1015 N SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-1446
Mailing Address - Country:US
Mailing Address - Phone:219-938-0920
Mailing Address - Fax:219-938-0923
Practice Address - Street 1:720 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-1808
Practice Address - Country:US
Practice Address - Phone:219-882-0262
Practice Address - Fax:219-882-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherFEDERA TAX ID