Provider Demographics
NPI:1720052277
Name:FOREST HILLS PEDIATRICS LLC
Entity Type:Organization
Organization Name:FOREST HILLS PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-232-5512
Mailing Address - Street 1:7495 STATE ROAD
Mailing Address - Street 2:STE 335
Mailing Address - City:CINTI
Mailing Address - State:OH
Mailing Address - Zip Code:45255
Mailing Address - Country:US
Mailing Address - Phone:513-232-5512
Mailing Address - Fax:513-232-3341
Practice Address - Street 1:7495 STATE ROAD
Practice Address - Street 2:STE 335
Practice Address - City:CINTI
Practice Address - State:OH
Practice Address - Zip Code:45255
Practice Address - Country:US
Practice Address - Phone:513-232-5512
Practice Address - Fax:513-232-3341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0170747Medicaid