Provider Demographics
NPI:1275993420
Name:ES PEDIATRIC PARTNERS LLC
Entity Type:Organization
Organization Name:ES PEDIATRIC PARTNERS LLC
Other - Org Name:RIVERSIDE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STEFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-833-8595
Mailing Address - Street 1:435 MARINA DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-2410
Mailing Address - Country:US
Mailing Address - Phone:843-833-8595
Mailing Address - Fax:
Practice Address - Street 1:435 MARINA DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2410
Practice Address - Country:US
Practice Address - Phone:843-833-8595
Practice Address - Fax:843-833-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34585208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ84256Medicaid
SCRHC031Medicaid