Provider Demographics
NPI:1841584356
Name:AUSTINTOWN PEDIATRICS INC
Entity Type:Organization
Organization Name:AUSTINTOWN PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:F
Authorized Official - Last Name:CAMPANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-797-0455
Mailing Address - Street 1:107 JAVIT CT
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2442
Mailing Address - Country:US
Mailing Address - Phone:330-797-0455
Mailing Address - Fax:
Practice Address - Street 1:107 JAVIT CT
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2442
Practice Address - Country:US
Practice Address - Phone:330-797-0455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2055065Medicaid