Provider Demographics
NPI:1982767562
Name:HYDE PARK PEDIATRICS, INC
Entity Type:Organization
Organization Name:HYDE PARK PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:513-321-0199
Mailing Address - Street 1:3330 ERIE AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1656
Mailing Address - Country:US
Mailing Address - Phone:513-321-0199
Mailing Address - Fax:513-321-0301
Practice Address - Street 1:3330 ERIE AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1656
Practice Address - Country:US
Practice Address - Phone:513-321-0199
Practice Address - Fax:513-321-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID NUMBER