Provider Demographics
NPI:1255427258
Name:WEST SIDE PEDIATRICS INC
Entity type:Organization
Organization Name:WEST SIDE PEDIATRICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-922-3200
Mailing Address - Street 1:663 ANDERSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-4751
Mailing Address - Country:US
Mailing Address - Phone:513-922-8200
Mailing Address - Fax:513-347-0082
Practice Address - Street 1:24095 STATELINE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025
Practice Address - Country:US
Practice Address - Phone:812-637-3900
Practice Address - Fax:812-637-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty