Provider Demographics
NPI:1265581409
Name:PEDIATRIC PLACE, INC
Entity type:Organization
Organization Name:PEDIATRIC PLACE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIWINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-831-7337
Mailing Address - Street 1:3690 ORANGE PL
Mailing Address - Street 2:STE 100
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4464
Mailing Address - Country:US
Mailing Address - Phone:216-831-7337
Mailing Address - Fax:216-595-0793
Practice Address - Street 1:3690 ORANGE PL
Practice Address - Street 2:STE 100
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4464
Practice Address - Country:US
Practice Address - Phone:216-831-7337
Practice Address - Fax:216-595-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2463794Medicaid