SOUTH PARK PEDIATRICS, INC (NPI# 1649638685) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649638685 |
| Entity Type | Organization |
| Organization Name | SOUTH PARK PEDIATRICS, INC |
| Other Organization Name | SOUTH PARK PEDIATRICS |
| Practice Address |
15821 S Park Ave South Holland IL 60473-1506 |
| Practice Telephone | 7082250200 |
| Practice Fax Number | 7082250202 |
| Mailing Telephone | 7082250200 |
| Mailing Fax Number | 7082250202 |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2016-02-05 |
| Authorized Official Name | DR. WENDELL A WHEELER (PRESIDENT) |
| Authorized Official Telephone | 7082250200 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
036068196 | IL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| South Park Pediatrics | Other Name - Individual/Organization |
| Street Address |
15821 S PARK AVE |
| City | SOUTH HOLLAND |
| State | IL |
| Zip Code | 60473-1506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902808611 | Wendell A Wheeler | Pediatrics | 15821 S Park Ave, South Holland, IL 60473-1506 | 2005-08-12 |
| 1134348246 | Jennifer Norris Rosas | Nurse Practitioner | 15821 S Park Ave, South Holland, IL 60473-1506 | 2007-04-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558826453 | Beverly Hadley, Dds P.C. | Dentist | 16282 Prince Drive, South Holland, IL 60473 | 2019-02-05 |
| 1053830828 | Caring Shepherds Health Care Inc | In Home Supportive Care | 15525 South Park Ave, Suite 103b, South Holland, IL 60473 | 2017-09-13 |
| 1972039469 | Dipeeka Patel | Nurse Practitioner | 430 E 162nd St # 487, South Holland, IL 60473 | 2017-05-03 |
| 1134576036 | A&j Transportation LLC | Non-emergency Medical Transport (VAN) | 16610 Langley Ave, South Holland, IL 60473 | 2016-05-20 |
| 1902204902 | Np Prn LLP | Clinic/Center | 16456 Dobson, South Holland, IL 60473 | 2014-12-08 |
| 1033415328 | Twfj Inc | Private Vehicle | 15059 Forestview, South Holland, IL 60473 | 2011-02-03 |
| 1871751396 | Arlene Gardner | Counselor | 16107 Lasalle Street, South Holland, IL 60473 | 2008-05-30 |
| 1952576233 | Harvey Family Center | Voluntary or Charitable | 16247 Wausau Ave., South Holland, IL 60473 | 2008-04-28 |
| 1548452725 | Chirospaaah | Chiropractor | 944 East 162nd St., South Holland, IL 60473 | 2007-08-13 |
| 1033313341 | Myra D Staples | Social Worker | 430 East 167th Street, South Holland, IL 60473 | 2007-06-12 |
| Find all providers in zip 60473 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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| 1215598891 | Vero Clinics | Clinic/Center | 1192 E Pershing Rd, Decatur, IL 62526-4753 | 2019-06-25 |
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| 1033699467 | Healthpointe Medical Center Sc | Clinic/Center | 530 Fullerton Rd Ste B, Swansea, IL 62226-2970 | 2018-08-15 |
| 1740794882 | Highland Park Cvs, L.L.C. | Clinic/Center | 72 Airport Plz, Bethalto, IL 62010-1774 | 2017-11-28 |
| 1447764014 | Dr Courtney Drendel Inc | Clinic/Center | 515 Hamilton St # 100, Geneva, IL 60134-2138 | 2017-11-19 |
| 1699206599 | David M Conner M.d. | Clinic/Center | 9 Executive Woods Ct Ste 2, Swansea, IL 62226-2016 | 2017-03-22 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH HOLLAND |
| Zip Code | 60473 |
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| 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.