| NPI | 1356690366 |
|---|---|
| NPI Type | NPI-2 Organization |
| Status | Active |
| Enumeration Date | 2012-09-05 |
| Last Updated | 2012-09-05 |
| Authorized Official | Nonna Ebalo president Phone: 4344703489 |
| Mailing Address | Po Box 774 South Boston, VA 24592-0774 United States Phone: (434) 572-3635 📍 View Map |
| Primary Practice Address | 2202 Beechmont Rd South Boston, VA 24592-1614 United States Phone: (434) 572-3635 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| MEDICAID | VA | 01046086 | - |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| Yes | 208000000X – Pediatrics | VA | 0101232220 |
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About NPI 1356690366
South Boston Pediatrics, Pc is an organization registered in the CMS NPPES NPI Registry with NPI number 1356690366. The primary specialty listed is Pediatrics. The organization is located in South Boston, VA. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2012-09-05. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1356690366?
NPI 1356690366 belongs to South Boston Pediatrics, Pc, a Pediatrics in South Boston, VA. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.
Is NPI 1356690366 active?
The current status of NPI 1356690366 in the NPPES registry is Active. The record was last updated on 2012-09-05.
What specialty is NPI 1356690366?
NPI 1356690366 is classified under the taxonomy Pediatrics. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1356690366?
You can verify NPI 1356690366 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1356690366?
The primary practice address on file for NPI 1356690366 is 2202 Beechmont Rd, South Boston, VA 24592-1614. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1356690366 issued?
NPI 1356690366 was first issued (enumerated) on 2012-09-05. The NPPES record was last updated on 2012-09-05.
Practice Location Map
South Boston Pediatrics, Pc is located at 2202 Beechmont Rd, South Boston, VA. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as South Boston Pediatrics, Pc. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1356690366. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Pediatrics | 0101232220 | VA |