Edgemont Pediatrics, P.C

LBN: Edgemont Pediatrics, P.C
Edgemont Pediatrics, P.C is an health care organization with primary practice located at 8710 State St , East Saint Louis IL 62203-2048. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as the primary health care specialty. Edgemont Pediatrics, P.C can be contacted via phone (618) 398-6601, or through Ogbevoen, Justin O via phone (618) 398-6601.

Contact Information

Primary practice address
8710 State St East Saint Louis IL 62203-2048
Phone: (618) 398-6601
Fax: (618) 398-4525
Website:
Map and Directions
Authorized official contact:
Name: Ogbevoen, Justin O Doctor of Medicine (MD)
Phone: (618) 398-6601

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 036085372 Illinois

Profile Details

NPI number 1689825838
LBN Legal business name Edgemont Pediatrics, P.C
DBA Doing business as
Authorized official Ogbevoen, Justin O Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Oct 7th, 2008
Last updated Oct 7th, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689825838 NPPES
Illinois MEDICAID 036085372

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