Provider Demographics
NPI:1457432627
Name:PEDIATRICS OF FLORENCE, PSC
Entity Type:Organization
Organization Name:PEDIATRICS OF FLORENCE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-525-8181
Mailing Address - Street 1:7309 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-5561
Mailing Address - Country:US
Mailing Address - Phone:859-525-8181
Mailing Address - Fax:859-525-8289
Practice Address - Street 1:7309 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5561
Practice Address - Country:US
Practice Address - Phone:859-525-8181
Practice Address - Fax:859-525-8289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
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
KY65932758Medicaid
KY65932758Medicaid