Organization
PEDIATRIC & INTERNAL MEDICINE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA CAWOOD (PRACTICE ADMINISTRATOR)
(765) 966-5527
Entity
Organization
Contact information
Practice address
1434 CHESTER BLVD, RICHMOND, IN 47374-1947
(765) 966-5527
(765) 966-5527
Mailing address
1434 CHESTER BLVD, RICHMOND, IN 47374-1947
(765) 966-5527
(765) 966-5527
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
50000450A
IN
208000000X
Pediatrics Physician
50000450A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0121808
—
OH
05
—
100255760A
—
IN
01
—
15D0360467
CLIA#
—
01
—
CI9605
MEDICARE RR
—
Enumeration date
07/04/2006
Last updated
04/23/2008
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