Provider Demographics
NPI:1710568233
Name:JC PEDS, LLC
Entity Type:Organization
Organization Name:JC PEDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:BIAS
Authorized Official - Last Name:FOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-606-7337
Mailing Address - Street 1:1705 CHRISTY DR STE 210
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-5195
Mailing Address - Country:US
Mailing Address - Phone:573-606-7337
Mailing Address - Fax:573-616-4459
Practice Address - Street 1:1705 CHRISTY DR STE 210
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-5195
Practice Address - Country:US
Practice Address - Phone:573-606-7337
Practice Address - Fax:573-616-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty