SOUTH BOSTON PEDIATRICS PC NPI 1356690366

NPI Information

  • NPI: 1356690366
  • Provider Name: SOUTH BOSTON PEDIATRICS, PC
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • CLIA Number: 49D2053393
  • Address: 2202 BEECHMONT RD
    SOUTH BOSTON, VA
    ZIP 24592
  • Phone: (434) 572-3635

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NPI Details

SOUTH BOSTON PEDIATRICS, PC is a pediatrics in South Boston, VA. The provider is 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. SOUTH BOSTON PEDIATRICS, PC NPI is 1356690366. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2202 BEECHMONT RD
SOUTH BOSTON, VA
ZIP 24592-614
Phone: (434) 572-3635

The provider's authorized official is Nonna Lyn Ebalo .
The authorized official title is President and has the following contact phone number (434) 470-3489.

The CLIA number assigned to this NPI record is 49D2053393 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/5/2012 and was last updated on 9/5/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatrics0101232220VIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
101046086MEDICAIDVIRGINIA
2H33153MEDICARE UPINVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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