| NPI | 1649353970 |
|---|---|
| Doing Business As | MED PEDS ASSOCIATES |
| Entity Type | Organization |
| Authorized Contact | DIRENDIA SHACKELFORD Managed Care Specialist 800-654-0889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: IL 036074737) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2008-09-03 |