Provider Demographics
NPI:1932664695
Name:THE PEDIATRICIANS OF HYDE PARK LLC
Entity Type:Organization
Organization Name:THE PEDIATRICIANS OF HYDE PARK LLC
Other - Org Name:PEDIATRICIANS OF HYDE PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-871-0684
Mailing Address - Street 1:3666 PAXTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1568
Mailing Address - Country:US
Mailing Address - Phone:513-871-0684
Mailing Address - Fax:513-871-0705
Practice Address - Street 1:3666 PAXTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1568
Practice Address - Country:US
Practice Address - Phone:513-871-0684
Practice Address - Fax:513-871-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty