Provider Demographics
NPI:1982776159
Name:GAHANNA PEDIATRICS, LLC
Entity Type:Organization
Organization Name:GAHANNA PEDIATRICS, LLC
Other - Org Name:DANIEL J HEINMILLER MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-933-0980
Mailing Address - Street 1:470 SILVER LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230
Mailing Address - Country:US
Mailing Address - Phone:614-933-0980
Mailing Address - Fax:614-933-0334
Practice Address - Street 1:470 SILVER LANE
Practice Address - Street 2:SUITE B
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230
Practice Address - Country:US
Practice Address - Phone:614-933-0980
Practice Address - Fax:614-933-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2140150Medicaid