Organization
PAVILION PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LOIS A CHRISTIAN (OFFICE MANAGER)
(765) 289-2616
Entity
Organization
Contact information
Practice address
2525 W UNIVERSITY AVE, SUITE 404, MUNCIE, IN 47303-3421
(765) 289-2616
(765) 741-3934
Mailing address
2525 W UNIVERSITY AVE, SUITE 404, MUNCIE, IN 47303-3421
(765) 289-2616
(765) 741-3934
Taxonomy
Speciality
Code
Description
License number
State
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
Primary
01040631A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100105670
—
IN
05
—
100362560
—
IN
05
—
200060380
—
IN
05
—
200465180
—
IN
05
—
200465710
—
IN
Enumeration date
05/22/2007
Last updated
06/29/2011
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