Edgemont Pediatrics, P.C

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036085372 Issued in IL

Legal business name

EDGEMONT PEDIATRICS, P.C

Practice address

8710 State St
East Saint Louis, IL 62203-2048

Phone

(618) 398-6601

Fax

(618) 398-4525

NPI assigned

Oct 7, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Justin O Ogbevoen, M.DNPI 1487612370

Title

Ceo

Phone

(618) 398-6601

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Justin O Ogbevoen, MD

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Florissant, MO
  • NPI 1487612370
  NPD (past) Authorized official

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1689825838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8710 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622032048",
            "telephone_number": "618-398-6601",
            "fax_number": "618-398-4525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8710 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622032048",
            "telephone_number": "618-398-6601",
            "fax_number": "618-398-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEMONT PEDIATRICS, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-07",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "OGBEVOEN",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-398-6601",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036085372",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036085372",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Breauna Latrice Dent, CNA
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• Deborah Dyle, LCSW
• East Side Health District
• East St Louis Dist 189
• Cheryl Lynn Eubanks
• Familia Dental Esl 4 LLC
• Familia Dental Esl 4LLC
• Familia Dental Esl LLC
• David Felts

• Pediatrics Physician in East Saint Louis, IL
• Providers in East Saint Louis, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; 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.