Basic Information
| Provider Information | |||||||||
| NPI: | 1669864815 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEARCE PEDIATRICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1033 | ||||||||
| Address2: | |||||||||
| City: | YORKVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605600896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303852594 | ||||||||
| FaxNumber: | 6303852778 | ||||||||
| Practice Location | |||||||||
| Address1: | 4511 SAUK TRL | ||||||||
| Address2: | |||||||||
| City: | RICHTON PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604711167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087476000 | ||||||||
| FaxNumber: | 7087476003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2015 | ||||||||
| LastUpdateDate: | 02/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | PEARCE | ||||||||
| AuthorizedOfficialFirstName: | FRANCINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 6303852594 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 036104943 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 036104943 | 05 | IL | MEDICAID |