Provider Demographics
NPI:1972691103
Name:PEDIATRIC CARE CENTER PC
Entity Type:Organization
Organization Name:PEDIATRIC CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIZWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JABIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-397-2326
Mailing Address - Street 1:ROUTE 403 SOUTH
Mailing Address - Street 2:PO BOX 268
Mailing Address - City:MARION CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:15759
Mailing Address - Country:US
Mailing Address - Phone:724-397-2326
Mailing Address - Fax:
Practice Address - Street 1:100 NEALE ADDRESS
Practice Address - Street 2:MAHONING MEDICAL CENTER
Practice Address - City:MARION CENTER
Practice Address - State:PA
Practice Address - Zip Code:15759-0268
Practice Address - Country:US
Practice Address - Phone:724-397-2326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA613096OtherPA BLUE SHIELD