Provider Demographics
NPI:1750552972
Name:SMART MOVES PEDIATRICS
Entity type:Organization
Organization Name:SMART MOVES PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:DENEAN
Authorized Official - Last Name:HAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:708-227-6593
Mailing Address - Street 1:7222 W CERMAK RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1422
Mailing Address - Country:US
Mailing Address - Phone:708-442-0023
Mailing Address - Fax:
Practice Address - Street 1:7222 W CERMAK RD
Practice Address - Street 2:SUITE 500
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1422
Practice Address - Country:US
Practice Address - Phone:708-442-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2008999261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities