IDEAL PEDIATRIC AND ADOLESCENT CARE
NPI 1154879096
Clinic/Center in Lewisburg, PA
- Organization
- Clinic/Center
- CLIA Number: 39D2122703
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 12-04-2026
About IDEAL PEDIATRIC AND ADOLESCENT CARE
This page provides the complete NPI Profile along with additional information for Ideal Pediatric And Adolescent Care, a provider established in Lewisburg, Pennsylvania operating as a Clinic/center. The healthcare provider is registered in the NPI registry with number 1154879096 assigned on September 2016. The practitioner's primary taxonomy code is 261Q00000X with license number OS008495L (PA). The provider is registered as an organization and their NPI record was last updated 10 years ago. The authorized official of this NPI record is Dr. Mary Beth Ann O'hara D.o. (President)
- NPI
- 1154879096 Verify this NPI
- Provider Name
- IDEAL PEDIATRIC AND ADOLESCENT CARE
- Entity Type
- Organization
- Location Address
- 121 JPM RD LEWISBURG, PA 17837
- Location Phone
- (570) 551-0300
- Mailing Address
- 121 JPM RD LEWISBURG, PA 17837
- Mailing Phone
- (570) 551-0300
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-21-2016
- Last Update Date
- 09-21-2016
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center
- Taxonomy Code
- 261Q00000X
- Type
- Ambulatory Health Care Facilities
- License No.
- OS008495L
- License State
- PA
- Taxonomy Description
- A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 39D2122703
- Facility Type
- Physician Office
- Certificate Effective Date
- December 05, 2024
- Certificate Expiration Date
- December 04, 2026
- Laboratory Director
- DR. MARY BETH OHARA
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Ideal Pediatric And Adolescent Care to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Other Providers at the Same Location
The following 4 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1154879096, enumerated as an "organization" on September 21, 2016.
The provider is located at 121 JPM RD LEWISBURG, PA 17837 and the phone number is (570) 551-0300.
Clinic/Center with taxonomy code 261Q00000X.
