Provider Demographics
NPI:1972551661
Name:FRANKLIN PARK PEDIATRICS
Entity type:Organization
Organization Name:FRANKLIN PARK PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-475-5433
Mailing Address - Street 1:2000 REGENCY CT.
Mailing Address - Street 2:STE 103
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623
Mailing Address - Country:US
Mailing Address - Phone:419-475-5433
Mailing Address - Fax:419-475-4770
Practice Address - Street 1:2000 REGENCY CT.
Practice Address - Street 2:STE 103
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623
Practice Address - Country:US
Practice Address - Phone:419-475-5433
Practice Address - Fax:419-475-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2274168Medicaid