| Ideal Pediatric And Adolescent Care | |
|
121 Jpm Rd Lewisburg PA 17837-9313 | |
| (570) 551-0300 | |
| Not Available |
| Full Name | Ideal Pediatric And Adolescent Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 121 Jpm Rd, Lewisburg, Pennsylvania |
| Authorized Official Name and Position | Mary Beth Ann O'hara (PRESIDENT) |
| Authorized Official Contact | 5705510300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ideal Pediatric And Adolescent Care 121 Jpm Rd Lewisburg PA 17837-9313 Ph: (570) 551-0300 | Ideal Pediatric And Adolescent Care 121 Jpm Rd Lewisburg PA 17837-9313 Ph: (570) 551-0300 |
| NPI Number | 1154879096 |
|---|---|
| Provider Enumeration Date | 09/21/2016 |
| Last Update Date | 09/21/2016 |
| Medicare PECOS PAC ID | 2769743970 |
|---|---|
| Medicare Enrollment ID | O20180305001585 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154879096 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | OS008495L (Pennsylvania) | Primary |
| Provider Name | Mary Beth O'hara |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1790746576 PECOS PAC ID: 8426286618 Enrollment ID: I20140115001080 |
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