Provider Demographics
NPI:1801511290
Name:HOPE CHEST PEDIATRICS LLC
Entity type:Organization
Organization Name:HOPE CHEST PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:COTALEEN
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:PNP
Authorized Official - Phone:314-457-3486
Mailing Address - Street 1:130 N DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:MARINE
Mailing Address - State:IL
Mailing Address - Zip Code:62061
Mailing Address - Country:US
Mailing Address - Phone:815-310-6222
Mailing Address - Fax:833-921-2135
Practice Address - Street 1:130 N DUNCAN ST
Practice Address - Street 2:
Practice Address - City:MARINE
Practice Address - State:IL
Practice Address - Zip Code:62061
Practice Address - Country:US
Practice Address - Phone:815-310-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty