South Charleston Pediatrics

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SOUTH CHARLESTON PEDIATRICS

Practice address

4607 Maccorkle Ave SW
Ste 400
Charleston, WV 25309-1364

Phone

(304) 766-4400

Fax

(304) 766-4417

NPI assigned

Dec 13, 2006

Organization subpart

No

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

Authorized official

Name

Jamie Beth Ray

Title

Office Manager

Phone

(304) 766-4469

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

South Charleston Pediatrics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• South Charleston Pediatrics

  • Pediatrics Physician
  • Charleston, WV
  • NPI 1639251036
  NPD tax ID

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962563593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4607 MACCORKLE AVE SW",
            "address_2": "STE 400",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253091364",
            "telephone_number": "304-766-4400",
            "fax_number": "304-766-4417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4607 MACCORKLE AVE SW",
            "address_2": "STE 400",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253091364",
            "telephone_number": "304-766-4400",
            "fax_number": "304-766-4417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CHARLESTON PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "304-766-4469"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6705182000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethany Sorgman
• Ashleigh Sosebee
• Donna Sottile
• Hebah Soudan, MBBS
• South Charleston Pediatrics
• South Hills Chiropractic, Inc.
• Southern Psychiatric Services
• Nathaniel Southern
• Steven C Southern, MD
• Southridge Advanced Chiropractic

• Clinical Medical Laboratory in Charleston, WV
• Providers in Charleston, WV by specialty
• Clinical Medical Laboratory in West Virginia

• 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.