| Grand Avenue Pediatrics | |
|
1402 Grand Ave Washington IN 47501-2122 | |
| (812) 257-0383 | |
| (812) 257-0433 |
| Full Name | Grand Avenue Pediatrics |
|---|---|
| Speciality | Clinic/Center |
| Location | 1402 Grand Ave, Washington, Indiana |
| Authorized Official Name and Position | Anthony Showalter (PRESIDENT OF THE BOARD OF DIRECTORS) |
| Authorized Official Contact | 8122548620 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Avenue Pediatrics 1402 Grand Ave Washington IN 47501-2122 Ph: (812) 257-0383 | Grand Avenue Pediatrics 1402 Grand Ave Washington IN 47501-2122 Ph: (812) 257-0383 |
| NPI Number | 1356468631 |
|---|---|
| Provider Enumeration Date | 03/23/2007 |
| Last Update Date | 01/02/2021 |
| Medicare PECOS PAC ID | 1557271665 |
|---|---|
| Medicare Enrollment ID | O20070424000017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356468631 | NPI | - | NPPES |
| 100270240C | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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