Organization Name: | RIDGE PEDIATRICS AND ADOLESCENT CENTER |
NPI Number: | 1013114818 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LINDA DELOACH (OFFICE MANAGER) |
Mailing Address: | 338 E Columbia Ave Suite E Leesville |
State: | SC US |
Postal Code: | 290709285 |
Phone Number: | 8035322877 |
Fax Number: | 8035325430 |
NPI Enumeration Date: | 06/27/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 12957 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |