Organization
RIDGE PEDIATRICS AND ADOLESCENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA DELOACH (OFFICE MANAGER)
(803) 532-2877
Entity
Organization
Contact information
Practice address
338 E COLUMBIA AVE, SUITE E, LEESVILLE, SC 29070-9285
(803) 532-2877
(803) 532-5430
Mailing address
338 E COLUMBIA AVE, SUITE E, LEESVILLE, SC 29070-9285
(803) 532-2877
(803) 532-5430
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12957
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3903
—
SC
Enumeration date
06/27/2007
Last updated
08/22/2020
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