Provider Demographics
NPI:1003052028
Name:COSKIDS PEDIATRICS LTD
Entity Type:Organization
Organization Name:COSKIDS PEDIATRICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATICK
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:618-233-6685
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-0217
Mailing Address - Country:US
Mailing Address - Phone:618-233-6685
Mailing Address - Fax:
Practice Address - Street 1:4212 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1835
Practice Address - Country:US
Practice Address - Phone:618-233-6685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079559208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty