Provider Demographics
NPI:1912008475
Name:PEDIATRICS & BEYOND LLC
Entity Type:Organization
Organization Name:PEDIATRICS & BEYOND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OSTEOPATHIC PHYSICIAN & SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MANSBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-627-0071
Mailing Address - Street 1:10663 RAYSTOWN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-7542
Mailing Address - Country:US
Mailing Address - Phone:814-627-0071
Mailing Address - Fax:814-627-0315
Practice Address - Street 1:10663 RAYSTOWN RD
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-7542
Practice Address - Country:US
Practice Address - Phone:814-627-0071
Practice Address - Fax:814-627-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010062L207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018492240004Medicaid
PA0018492240004Medicaid
PA075001Medicare ID - Type Unspecified