Provider Demographics
NPI:1871647818
Name:RIVER HILLS PEDIATRICS
Entity Type:Organization
Organization Name:RIVER HILLS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:OTREMBIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-781-1310
Mailing Address - Street 1:525 ALEXANDRIA PIKE STE 320
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:KY
Mailing Address - Zip Code:41071-3243
Mailing Address - Country:US
Mailing Address - Phone:859-781-1310
Mailing Address - Fax:859-572-3021
Practice Address - Street 1:525 ALEXANDRIA PIKE STE 320
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:KY
Practice Address - Zip Code:41071
Practice Address - Country:US
Practice Address - Phone:859-781-1310
Practice Address - Fax:859-572-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65903759Medicaid