NPIMap

Organization Active NPI

TLC Pediatrics LTS

  • Pediatrics Physician
  • Belleville, IL
National Provider Identifier
1326106246
Registry record updated Dec 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036092496 Issued in IL
Legal business name
TLC PEDIATRICS LTS
Practice address
4600 Memorial Dr
Ste 280
Belleville, IL 62226-5366
Phone
(618) 257-9814
Fax
(618) 257-9802
NPI assigned
Dec 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2013

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

Authorized official

Name
Dr. Stacie Sharon Laff, MDNPI 1851318489
Title
President
Phone
(618) 257-9814

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 036092496 IL Primary

Addresses

Primary practice location

4600 Memorial Dr
Ste 280
Belleville, IL 62226-5366

Mailing address

4600 Memorial Dr
Ste 280
Belleville, IL 62226-5366
Phone (618) 257-9814

Other identifiers 1

IdentifierTypeStateIssuer
08232033OtherBCBS OF IL

National Provider Directory

National Provider Directory

Locations

4600 Memorial Dr
Ste 280
Belleville, IL 62226
Phone (618) 257-2800

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385942400000",
    "number": "1326106246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR",
            "address_2": "STE 280",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265366",
            "telephone_number": "618-257-9814",
            "fax_number": "618-257-9802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR",
            "address_2": "STE 280",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265366",
            "telephone_number": "618-257-9814",
            "fax_number": "618-257-9802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLC PEDIATRICS LTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2013-12-02",
        "status": "A",
        "authorized_official_last_name": "LAFF",
        "authorized_official_first_name": "STACIE",
        "authorized_official_middle_name": "SHARON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-257-9814",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036092496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "08232033",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2013; 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.