Ridge Pediatrics and Adolescent Center

Primary specialty

SpecialistTaxonomy code 174400000X

License

12957 Issued in SC

Legal business name

RIDGE PEDIATRICS AND ADOLESCENT CENTER

Practice address

338 E Columbia Ave
Suite E
Leesville, SC 29070-9285

Phone

(803) 532-2877

Fax

(803) 532-5430

NPI assigned

Jun 27, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Linda Deloach

Title

Office Manager

Phone

(803) 532-2877

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013114818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "338 E COLUMBIA AVE",
            "address_2": "SUITE E",
            "city": "LEESVILLE",
            "state": "SC",
            "postal_code": "290709285",
            "telephone_number": "803-532-2877",
            "fax_number": "803-532-5430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "338 E COLUMBIA AVE",
            "address_2": "SUITE E",
            "city": "LEESVILLE",
            "state": "SC",
            "postal_code": "290709285",
            "telephone_number": "803-532-2877",
            "fax_number": "803-532-5430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGE PEDIATRICS AND ADOLESCENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DELOACH",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "803-532-2877",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "SC",
            "license": "12957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3903",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Catherine Cantrell Oxner, PH.D.
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• Stephanie Sawyer, MSP, CCC-SLP
• Gary Lynn Sheaffer Jr., PT
• Kenneth Shelton II
• Sara E Shockney, O.D.

• Specialist in Leesville, SC
• Providers in Leesville, SC by specialty
• Specialist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.