Provider Demographics
NPI:1053577387
Name:A TO Z PEDIATRICS, LLP
Entity type:Organization
Organization Name:A TO Z PEDIATRICS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:EBERHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-623-9468
Mailing Address - Street 1:1230 GEORGE E. CHANCE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CASEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62232
Mailing Address - Country:US
Mailing Address - Phone:618-345-5437
Mailing Address - Fax:618-377-8279
Practice Address - Street 1:1230 GEORGE E. CHANCE PARKWAY
Practice Address - Street 2:
Practice Address - City:CASEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62232
Practice Address - Country:US
Practice Address - Phone:618-345-5437
Practice Address - Fax:618-377-8279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.115360208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty