SOUTH BOSTON PEDIATRICS, PC (NPI# 1356690366) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356690366 |
| Entity Type | Organization |
| Organization Name | SOUTH BOSTON PEDIATRICS, PC |
| Practice Address |
2202 Beechmont Rd South Boston VA 24592-1614 |
| Mailing Address |
Po Box 774 South Boston VA 24592-0774 |
| Practice Telephone | 4345723635 |
| Mailing Telephone | 4345723635 |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2012-09-05 |
| Authorized Official Name | DR. NONNA LYN EBALO (PRESIDENT) |
| Authorized Official Telephone | 4344703489 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 0101232220 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 01046086 | 05 |
| Street Address |
2202 BEECHMONT RD |
| City | SOUTH BOSTON |
| State | VA |
| Zip Code | 24592-1614 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700891306 | Community Phcy of South Boston,inc | Pharmacy | 2202 Beechmont Rd, South Boston, VA 24592-1614 | 2006-07-30 |
| 1316396112 | Urology of Virginia, Pllc | Urology | 2202 Beechmont Rd, Suite A, South Boston, VA 24592-1614 | 2016-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154966398 | Transformations Center for Health Wellness LLC | Counselor | 2170 Sandy Beach Road, South Boston, VA 24592 | 2019-11-12 |
| 1740830215 | Kirstyn Lokker | Occupational Therapist | 1 High School Circle, South Boston, South Boston, VA 24592 | 2019-09-17 |
| 1841764248 | Nicole Ivey | Occupational Therapy Assistant | 103 Rosehil Rd, South Boston, VA 24592 | 2019-01-18 |
| 1841700960 | Bio-medical Applications of Virginia, Inc. | Clinic/Center | 130 Aubreys Loop, South Boston, VA 24592 | 2017-10-03 |
| 1659828820 | Family Preservation Services, Inc | Community/Behavioral Health | 1 High School Circle, South Boston, VA 24592 | 2016-09-06 |
| 1316222821 | Family and Children Enrichment Services Inc. | Health Maintenance Organization | 220 Paradise Lane, South Boston, VA 24592 | 2011-10-15 |
| 1326365578 | Brinda Howard | Nurse's Aide | 104 Love Shop Park Rd Lot #25, South Boston, VA 24592 | 2010-04-28 |
| 1356513543 | Betts Medical Supplies, LLC. | Durable Medical Equipment & Medical Supplies | 403 Factory Street, Suite B, South Boston, VA 24592 | 2008-03-27 |
| 1407051873 | Dominion Health Medical Assoc | Legal Medicine | 101 Aubrey's Loop Rd, South Boston, VA 24592 | 2007-06-18 |
| 1437352945 | Behavioral Health Associates, Inc. | Non-emergency Medical Transport (VAN) | 515 Yancey Ave, South Boston, VA 24592 | 2007-06-11 |
| Find all providers in zip 24592 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861472524 | Nonna Lyn M Ebalo | Pediatrics | 2212 Wilborn Ave, South Boston, VA 24592-1630 | 2006-01-19 |
| 1457756322 | Dominion Health Medical Assoc | Pediatrics | 101 Aubreys Loop, South Boston, VA 24592-5054 | 2014-11-04 |
| 1588920284 | Amelia Fisher | Pediatrics | 409 W Broadway, South Boston, MA 02127-2245 | 2012-04-06 |
| 1164721668 | Anne Jennifer Lombardi | Pediatrics | 2100 Wilborn Ave, South Boston, VA 24592-1628 | 2011-03-23 |
| 1578633301 | Jason Channing Coleman | Pediatrics | 2100 Wilborn Ave, South Boston, VA 24592-1628 | 2006-11-09 |
| 1407891815 | Fuller-roberts Clinic, Inc | Pediatrics | 2212 Wilborn Ave, South Boston, VA 24592-1630 | 2006-06-19 |
| 1639147739 | Samantha Y King | Pediatrics | 1627 Seymour Dr, South Boston, VA 24592-3447 | 2006-03-14 |
| 1386612877 | Maria Precious Tangan Torres | Pediatrics | 2100 Wilborn Ave, South Boston, VA 24592-1628 | 2006-03-09 |
| 1487628087 | Virginia Fitzgerald | Pediatrics | 409 W Broadway, South Boston, MA 02127-2245 | 2006-02-13 |
| 1831163443 | Nisha Thakrar | Pediatrics | 409 W Broadway, South Boston, MA 02127-2245 | 2006-02-13 |
| Find all providers in SOUTH BOSTON | ||||
| City | SOUTH BOSTON |
| Zip Code | 24592 |
Please comment or provide details below to improve the information on SOUTH BOSTON PEDIATRICS, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.