Provider Demographics
NPI:1356462253
Name:SOUTH COUNTY PEDIATRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:SOUTH COUNTY PEDIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:I
Authorized Official - Last Name:ORTIZ-ARROYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-849-3320
Mailing Address - Street 1:4850 LEMAY FERRY RD
Mailing Address - Street 2:STE 120
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1576
Mailing Address - Country:US
Mailing Address - Phone:314-849-3320
Mailing Address - Fax:314-849-7766
Practice Address - Street 1:4850 LEMAY FERRY RD
Practice Address - Street 2:STE 120
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129
Practice Address - Country:US
Practice Address - Phone:314-849-3320
Practice Address - Fax:314-849-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty