Organization
LEBANON PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE S. THOMAS M.D. (PROPRIETOR)
(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 WEST HIGH STREET, LEBANON, KY 40033
(270) 692-5811
(270) 692-3863
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
32504
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65934671
—
KY
Enumeration date
10/23/2006
Last updated
12/14/2007
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