Provider Demographics
NPI:1043498041
Name:PEDIATRIC ASSOCIATES SC
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY CARE PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-288-4824
Mailing Address - Street 1:2011 EAST 75TH STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3646
Mailing Address - Country:US
Mailing Address - Phone:773-288-4824
Mailing Address - Fax:773-288-3995
Practice Address - Street 1:2011 EAST 75TH STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3646
Practice Address - Country:US
Practice Address - Phone:773-288-4824
Practice Address - Fax:773-288-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036037561208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty