Healthcare Provider Details

I. General information

NPI: 1578596284
Provider Name (Legal Business Name): PEDIATRICS SOUTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MOUNT LEBANON BLVD
PITTSBURGH PA
15234-1243
US

IV. Provider business mailing address

240 MOUNT LEBANON BLVD
PITTSBURGH PA
15234-1243
US

V. Phone/Fax

Practice location:
  • Phone: 412-561-7541
  • Fax: 412-561-2366
Mailing address:
  • Phone: 412-561-7541
  • Fax: 412-561-2366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT L. TYSON
Title or Position: CEO
Credential: MD
Phone: 412-561-7541