Provider Demographics
NPI:1730465881
Name:PEDIATRIC ASSOCIATES OF OTTUMWA, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF OTTUMWA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-682-5451
Mailing Address - Street 1:921 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501
Mailing Address - Country:US
Mailing Address - Phone:641-682-5451
Mailing Address - Fax:641-682-0511
Practice Address - Street 1:921 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501
Practice Address - Country:US
Practice Address - Phone:641-682-5451
Practice Address - Fax:641-682-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23196208000000X
IA28019208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty