Provider Demographics
NPI:1851784755
Name:SUBURBAN PEDIATRICS
Entity Type:Organization
Organization Name:SUBURBAN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-336-6700
Mailing Address - Street 1:9600 CHILDREN DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6791
Mailing Address - Country:US
Mailing Address - Phone:513-336-6700
Mailing Address - Fax:513-398-2109
Practice Address - Street 1:9600 CHILDREN DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6791
Practice Address - Country:US
Practice Address - Phone:513-336-6700
Practice Address - Fax:513-398-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0080961Medicaid