Organization
LEBANON PEDIATRICS LLC
Active
Parent organization
LEBANON PEDIATRICS, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LEBANON PEDIATRICS, LLC
Authorized official
DR. DIANE S THOMAS M.D. (PRESIDENT)
(270) 692-5811
Entity
Organization
Contact information
Practice address
311 W HIGH ST, LEBANON, KY 40033-1427
(270) 692-5811
(270) 692-3863
Mailing address
311 W HIGH ST, LEBANON, KY 40033-1427
(270) 692-5811
(270) 692-3863
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78905148
—
KY
Enumeration date
04/16/2008
Last updated
04/16/2008
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