Provider Demographics
NPI:1598808164
Name:FENTON PEDIATRICS, L.L.C.
Entity Type:Organization
Organization Name:FENTON PEDIATRICS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-349-5437
Mailing Address - Street 1:714 GRAVOIS RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7727
Mailing Address - Country:US
Mailing Address - Phone:636-349-5437
Mailing Address - Fax:636-349-6663
Practice Address - Street 1:714 GRAVOIS RD
Practice Address - Street 2:STE. 200
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7727
Practice Address - Country:US
Practice Address - Phone:636-349-5437
Practice Address - Fax:636-349-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty