Provider Demographics
NPI:1871529222
Name:SNIFFLES & SMILES PEDIATRICS, INC.
Entity type:Organization
Organization Name:SNIFFLES & SMILES PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-695-9470
Mailing Address - Street 1:135 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-1586
Mailing Address - Country:US
Mailing Address - Phone:740-695-9470
Mailing Address - Fax:740-695-3674
Practice Address - Street 1:135 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1586
Practice Address - Country:US
Practice Address - Phone:740-695-9470
Practice Address - Fax:740-695-3674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080667208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2302672Medicaid
OH9356851Medicare PIN
OH2302672Medicaid