| Healthsource: Eastgate Pediatrics | |
|
4627 Aicholtz Rd Cincinnati OH 45244-1447 | |
| (513) 753-2820 | |
| (513) 753-2824 |
| Full Name | Healthsource: Eastgate Pediatrics |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 4627 Aicholtz Rd, Cincinnati, Ohio |
| Authorized Official Name and Position | William Marois (CFO) |
| Authorized Official Contact | 5135767700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthsource: Eastgate Pediatrics 424 Wards Corner Rd Ste 200 Loveland OH 45140-6966 Ph: (513) 707-4011 | Healthsource: Eastgate Pediatrics 4627 Aicholtz Rd Cincinnati OH 45244-1447 Ph: (513) 753-2820 |
| NPI Number | 1780701417 |
|---|---|
| Provider Enumeration Date | 03/26/2007 |
| Last Update Date | 04/30/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780701417 | NPI | - | NPPES |
| 0281707 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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