Basic Information
| Provider Information | |||||||||
| NPI: | 1568116317 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEART OF OHIO PEDIATRICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1671 W MAIN ST | ||||||||
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| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430551345 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1671 W MAIN ST | ||||||||
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| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430551345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142971158 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2022 | ||||||||
| LastUpdateDate: | 02/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | FOUST | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6142971158 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 02/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.